The Future of Cancer Diagnostics and Treatment? Liquid Biopsies

Follow me in learning about liquid biopsies, and how they can save lives!

10 min readMar 1, 2021

I am sure most of us have had a family member, or someone we know, receive the dreaded diagnosis of cancer. A diagnosis that can change a person and their family’s lives forever. I remember, when I was just five, visiting my grandpa for the last time before he passed away from leukemia. So many people across the world have to watch their mom, dad, sister, brother, or other family members suffer from cancer. But did you know that many of them were diagnosed too late? Approximately 12.7 million people are diagnosed with cancer each year of whom almost 7.6 million die. Did you know that roughly one third of them could have been saved by an earlier diagnosis and more specific intervention?

In this article, I am going to discuss a new cancer detection diagnostic device called a liquid biopsy that could save millions of people. Read on to learn more about an innovation that could change the face of cancer diagnostics and treatment forever!

What Exactly is a Liquid Biopsy?

You may be wondering, “What on earth is a liquid biopsy and how could it possibly help millions of people??” Well by the end of this article, you will find out how important this new process is and you will wonder why you haven’t heard of it before!

Liquid biopsy is a fairly new, simple non-invasive procedure that is used instead of a surgical biopsy and allows scientists to detect traces of cancer in a small sample of body fluids such as blood, saliva, cerebral spinal fluid (liquid surrounding your brain), etc. How cool is that?!! This biopsy is non-invasive and when using blood, only requires 5 milliliters (equivalent to a teaspoon!) which is spun in a centrifuge to separate the plasma in the blood from the red and white blood cells. This plasma is then tested for cancer markers. The three main cancer markers found in the bodily fluids are:

Circulating Tumor Cells (CTC’s) These cells are released into the bloodstream from a cancerous tumor as it grows. CTC’s can be detected by certain equipment indicating cancer is present even before a patient presents with symptoms. This is especially important with cancers that are slow to present symptoms such as pancreatic cancer which kills 95% of people who are diagnosed. If you are starting to think this could be a game changer, you are absolutely right!
Circulating Tumor DNA (ctDNA) As cancer cells die, they release DNA into the bloodstream. This DNA excites many scientists as they are able to use this information to gather more detailed information about the tumor. This means they can develop a specific and therefore more effective treatment plan for a patient. How exciting is that?!
Exosomes Cancer cells release high amounts of exosomes which are essentially a bubble containing fluid from the cancer cells along with genetic material and proteins. Think of an exosome as a suitcase packed with important contents that travels from one place to another. In this case, an exosome is travelling from the cancerous tumor through the bloodstream to other systems. The cool thing about exosomes is that they can detect cancer in many different bodily systems. For example, a cancer located near the mouth could be detected in saliva, or a cancer near the kidneys or bladder could be detected in urine.

Here is a quick diagram to sum it all up:

Liquid biopsies are a fairly new diagnostic technique and many companies are still in the clinical trial phases. However, there are many tests using liquid biopsies that have been approved and are currently being used today! Many companies are making breakthroughs that will change the way we diagnose and treat cancer forever.

After reading this, you may be thinking, what is the difference between a liquid biopsy and a regular cancer detection system such as a tissue biopsy? Well don’t you worry! Your questions will be answered very soon… 🤫

The Difference Between a Tissue Biopsy and a Liquid Biopsy

Now you may be wondering, why not use a traditional biopsy for cancer detection and treatment? Well, let me explain…

A traditional biopsy involves a needle being inserted into a tumor and removing tissue to test it for cancer markers on a slide under a microscope. These biopsies are often painful, invasive, and do not provide an early detection option as this method can only be used once a mass is discovered.

Now we get to the liquid biopsy. A liquid biopsy allows you to detect cancer growth before any clinical symptoms are present or anything would show up on a PET or CAT scan. Most cancers also have multiple genetic mutations that may be different depending on the part of the cancer being tested. Tissue samples biopsied may not show all mutations as they only puncture one part of the mass; whereas, liquid biopsies offer an improved chance of early detection.

Comparison of a tissue biopsy and a liquid biopsy.

“Liquid biopsies could be a game-changer in cancer testing,” said Miro Venturi, Roche’s Global Head of Diagnostics Biomarkers. “In terms of patient acceptability and disease management, the benefits of non-invasive, quick and easily repeatable tests are clear. And in the longer term, liquid biopsies may ultimately be used to catch signs of cancer early, before symptoms arise. This could make a significant difference to the way we understand and treat cancer.”

Although liquid biopsies are still fairly new to the scene, they are very useful and once further developed, they could fully eliminate the need for tissue biopsies in most cancer cases. That said, some cancers will still require a tissue biopsy.

So to sum it up, liquid biopsies are the way of the future!

How Liquid Biopsies are Being used Currently

Diagram of Breast cancer detection through liquid biopsy. Image from The National Cancer Institute.

Many biotechnology companies are working on products that will revolutionize how we use liquid biopsies. Liquid biopsies are currently used to determine treatments for those who have advanced metastatic cancer. They are successfully being used to determine courses of treatment for those who have certain types of cancers. As of 2021, the FDA has approved the usage of liquid biopsies for lung, breast, ovarian, and prostate cancers.

Displayed below is a list of the current uses of liquid biopsies:

Diagnosis- Although in its infancy, these biopsies are being used to diagnose certain types of cancer in their early stages
Treatment options- These biopsies can help scientifically determine what cancer treatments would work best to shrink a specific tumor
Monitoring- Biopsies can help monitor cancer treatments and analyze whether the current treatment is working or if the cancer is metastasizing (meaning spreading to other parts of the body)

Since liquid biopsies are fairly new, their full potential has not yet been discovered and many companies are working hard to find the full potential of how liquid biopsies could help cancer patients. “What companies?”, you may ask. Perfect timing as we are covering that next.

Pioneering Companies?

Roche , based in Basel, Switzerland is one of the frontrunner companies innovating with liquid biopsies . This biotech company is attempting to revolutionize the prognostic and predictive management of lung cancer genotyping and pain management using liquid biopsy. Currently, Roche’s liquid biopsy tests can identify 70 cancer tumor mutations. You read that right…70!!
Thrive Detect is located in Boston, Massachusetts and has developed a technology called CancerSEEK utilizing liquid biopsies. This test is designed to detect different types of cancer before clinical symptoms appear. In the future, the company hopes that this blood test could be performed along with other routine medical care such as other blood tests or scans from your family doctor. Their clinical trial was successful with 30% more cancers being detected early than with a regular cancer detection tool. That’s more moms, dads, grandparents who could potentially be saved by early detection!
Biocept is a company located in San Diego, California that focuses on improving cancer patients’ lives through liquid biopsy tests. They currently have 3 liquid biopsy tests developed to help oncologists detect and monitor a cancer patient’s biomarkers. These three tests are: Target Selector®, OncoCEE®, and CEE-Sure™. Below is a diagram of how a CEE-Sure™ test can detect certain biomarkers using CTCs and ctDNA!

Any Recent Advancements?

Since liquid biopsies are so new, there are many recent advances coming out relating to cancer detection. Some of these relate to how a liquid biopsy could help gage the effectiveness of cancer treatments after the original cancer has just started to spread to other parts of the body.

A recent clinical study involving colorectal cancer used liquid biopsies to determine whether treatments are effective or whether patients required further surgeries. Liquid biopsies for colorectal cancer can detect tumor DNA that has been released from the cancer into the bloodstream or the urine. The clinical trial showed that circulating tumor DNA levels were directly related to better responses to early chemotherapy.

“We will need to develop more sensitive techniques to detect colorectal tumor DNA in urine to make this a useful clinical test. But this is a promising start.” says senior author Aadel A. Chaudhuri, Assistant Professor of Radiation Oncology at Washington University School of Medicine in St. Louis.

Benefits of Liquid Biopsies During COVID-19?

The COVID pandemic has delayed thousands of tissue biopsies that are desperately needed to diagnose cancers. However, a new project was started called, Project ACTT. This project allowed more than 800 cancer patients to be tested through liquid biopsies. This project is led by Canexa Health, located in Vancouver, British Columbia.

This project allows people living in remote areas to go to any blood clinic to get a blood test, which is then shipped to be analyzed for cancer DNA. It also allows those who are immunocompromised to be able to avoid hospitals for as long as possible during this Pandemic. Eleven percent of the samples came from remote areas and the studies so far suggest that the liquid biopsies, in most cases, are just as accurate as a regular tissue biopsy.

One patient in the trial named Carla Van MacDonald, living in Shallow Lake, Ontario, was able to get into two cancer drug trials for her breast cancer as this test detected a specific mutation in her tumor. She was able to draw the blood required for the test at a local LifeLabs and then ship it to Toronto, where it was analyzed. Not only has this allowed her to enter early trials but she was able to avoid a long commute to a hospital and delays in obtaining a standard tissue biopsy. I would consider this a win any which way you look at it!

Future Usage of Liquid Biopsies?

Liquid biopsies are showing great promise. Scientists believe the current trials and research are only the tip of the iceberg. It is hoped that in the future liquid biopsies will be used routinely along with other tests such as mammograms and colonoscopies to reduce the risk of late cancer detection for everyone. It will also allow those who live in remote areas the ability to be tested early through simple, non-invasive liquid biopsies.

It is also hoped that in the near future, liquid biopsies will be able to identify a greater number of cancer biomarkers for analysis.

Takeaways!

Liquid biopsies are a new technology that could change the way cancer is diagnosed and treated forever.

There are many companies who are working on clinical trials that vary from diagnosing cancers to implementing liquid biopsies as a routine test for all citizens.

We can all be comforted that in the future, liquid biopsies will be something else in our medical toolbox we can deploy to help detect and treat cancers early — saving the lives of the ones we love!

References-

5, M. (2019, December 17). What Are Liquid Biopsies and How Are They Used? Retrieved from https://www.cancer.net/blog/2018-03/what-are-liquid-biopsies-and-how-are-they-used

Cancer is Curable. Know Earlier, Take Action Together — Thrive Detect. (2021, January 05). Retrieved from https://thrivedetect.com/

Doing now what patients need next. (n.d.). Retrieved from https://www.roche.com/

Liquid biopsy. (n.d.). Retrieved from https://diagnostics.roche.com/global/en/article-listing/liquid-biopsy.html#:~:text=Roche is at the forefront of innovating liquid,growth factor receptor (EGFR) gene associated with NSCLC.

Liquid biopsy could guide therapy for colorectal cancer. (2021, February 25). Retrieved from https://www.futurity.org/liquid-biopsy-colorectal-cancer-2523222/

Liquid biopsy for early cancer detection — Canadian Cancer Society. (2017, November 15). Retrieved from https://www.cancer.ca/en/research-horizons/1/8/f/liquid-biopsy-for-early-cancer-detection/#:~:text=A liquid biopsy looks for signs of cancer,and “non-invasive,” causing relatively little pain or discomfort.

Mahajan, D. S., & About Dr Surbhi MahajanDr Surbhi Mahajan. (2018, May 06). Liquid Biopsy Procedure, Uses and Limitations. Retrieved from https://medcaretips.com/liquid-biopsy/#:~:text=It is believed that in future, these tests, could be used to guide cancer treatment decisions.

McDowell, S. (2018, February 12). Liquid Biopsy: Past, Present, Future. Retrieved from https://www.cancer.org/latest-news/liquid-biopsies-past-present-future.html

We are dedicated to one thing: Improving outcomes for cancer patients. (n.d.). Retrieved from https://biocept.com/

Mercer, G. (2021, February 04). Pilot of new cancer test in Canada shows promise as faster alternative to conventional biopsies. Retrieved from https://www.theglobeandmail.com/canada/article-pilot-of-new-cancer-test-in-canada-shows-promise-as-faster-alternative/

The Lancet Oncology. (2016). Liquid cancer biopsy: the future of cancer detection? The Lancet Oncology, 17(2), 123. Retrieved from https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)00016-4/fulltext