Liquid biopsy enters the clinic - implementation issues and future challenges.
Michail IgnatiadisGeorge W SledgeStefanie S JeffreyPublished in: Nature reviews. Clinical oncology (2021)
Historically, studies of disseminated tumour cells in bone marrow and circulating tumour cells in peripheral blood have provided crucial insights into cancer biology and the metastatic process. More recently, advances in the detection and characterization of circulating tumour DNA (ctDNA) have finally enabled the introduction of liquid biopsy assays into clinical practice. The FDA has already approved several single-gene assays and, more recently, multigene assays to detect genetic alterations in plasma cell-free DNA (cfDNA) for use as companion diagnostics matched to specific molecularly targeted therapies for cancer. These approvals mark a tipping point for the widespread use of liquid biopsy in the clinic, and mostly in patients with advanced-stage cancer. The next frontier for the clinical application of liquid biopsy is likely to be the systemic treatment of patients with 'ctDNA relapse', a term we introduce for ctDNA detection prior to imaging-detected relapse after curative-intent therapy for early stage disease. Cancer screening and diagnosis are other potential future applications. In this Perspective, we discuss key issues and gaps in technology, clinical trial methodologies and logistics for the eventual integration of liquid biopsy into the clinical workflow.
Keyphrases
- papillary thyroid
- early stage
- clinical trial
- squamous cell
- circulating tumor
- ultrasound guided
- fine needle aspiration
- bone marrow
- peripheral blood
- ionic liquid
- induced apoptosis
- primary care
- clinical practice
- healthcare
- high throughput
- small cell lung cancer
- squamous cell carcinoma
- lymph node metastasis
- cell cycle arrest
- young adults
- photodynamic therapy
- randomized controlled trial
- signaling pathway
- current status
- childhood cancer
- radiation therapy
- endoplasmic reticulum stress
- climate change
- preterm birth
- cell free
- mass spectrometry
- single molecule
- dna methylation
- cell proliferation
- open label
- rectal cancer
- combination therapy
- replacement therapy
- real time pcr