Lung cancer not just smokers’ disease

ALCMI and Inivata use liquid biopsy to study ctDNA in early-stage lung cancer

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SAN CARLOS, Calif.—Targeted toward transforming lung cancer into a chronically managed disease by 2023, the patient-founded nonprofit Addario Lung Cancer Medical Research Institute (ALCMI) has launched a new lung cancer study along with Cambridge, U.K.-based Inivata, using the latter’s InVision liquid biopsy platform.
The LIBERTI (Liquid Biopsy in Early Stage NSCLC Resected Lung Tumor Investigation) study will recruit up to 500 patients across approximately 10 ALCMI member institutions in the United States, led by co-principal investigators Ramaswamy Govindan, a professor of medicine, and Daniel Morgensztern, an associate professor, both at the Washington University School of Medicine in St. Louis.
Liquid biopsy extracts a small blood sample from a patient, screening it for genetic markers that indicate the presence of circulating tumor DNA (ctDNA). With the development of increasingly sensitive sequencing and analysis techniques, researchers are now able to identify tiny fragments of ctDNA shed from cancerous tumors, which contain genetic information that can help stratify patients, monitor treatment progress and identify emerging resistance.
The five-year study’s primary goal is to correlate the presence of ctDNA following surgical resection with disease recurrence in non-small cell lung cancer (NSCLC). Additional objectives include exploring the role of ctDNA in the ongoing monitoring of patients during and following therapies administered following surgery, with a view toward improving long-term outcomes.
“The ability to monitor for cancer recurrence in NSCLC patients post-surgery, where existing tools are very poor, would be enormously beneficial for patients,” Govindan states. “It would potentially allow for earlier and better targeted treatment and could have a significant effect on patient outcomes. The sensitivity of liquid biopsy assays, and the fact that they can be used repeatedly with a simple blood draw, makes them ideally suited for use in this setting.”
The study involves using InVision analysis to determine the potential role of ctDNA in measuring minimal residual disease in patients following surgical resection in NSCLC in order to help identify those patients who are in need of further therapy, and explore the value of ctDNA in monitoring for relapse.
“It is studies like this that will help lung cancer patients as they continue the fight for survival,” states Bonnie Addario, a lung cancer survivor and the founder of both the Bonnie J. Addario Lung Cancer Foundation (ALCF) and ALCMI. “As a survivor, I believe that less invasive and more timely ways to detect and treat residual disease will truly benefit patients.”
By providing access to critical masses of patient stakeholders, academic, community and industry researchers, ALCMI and ALCF are making progress toward a shared goal of transforming lung cancer into a chronically managed disease by 2023, she says.
Writing in a May 17 Huffington Post blog, Addario stated, “Lung cancer is a stealthy, efficient killer. Its garden-variety symptoms—a nagging cough, bronchitis, maybe some chest pain or shortness of breath—raise no alarms for most people, and by the time they appear, the cancer is already in its advanced stages.”
Tumors that are small enough to still be considered curable “are often too small to even show up,” Addario wrote. “For decades, doctors have struggled to respond quickly to lung cancer patients. And for decades, that battle has been lost.”
Contrary to the stigma that this is a “smokers’ disease,” lung cancer is increasingly recognized as a threat to non-smokers as well, Addario says. In fact, approximately 18 percent of the 228,000 new cases in the United States alone each year are diagnosed in people who have never smoked.
“This liquid biopsy might be superior to the standard lung tissue biopsy process, which poses risks to the patient, is painful and requires weeks before genetic testing results are produced—a critical time lost to waiting,” Addario remarks. “The liquid biopsy, by contrast, produces results in a few days with little more than a blood test and identifies which mutation is driving the cancer, thus giving doctors a roadmap to more effective treatment.”
One day, she says, “liquid biopsy tests may help diagnose lung cancer long before its symptoms emerge, offering hope instead of a death sentence to patients whose best chance at survival is early detection.”
Public bias and the stigma attached to lung cancer as a disease that victims “bring upon themselves” have also stalled progress in conquering lung cancer, she has noted. Of all the major cancers, lung cancer is by far the least-funded per death in terms of federal research dollars.
Clive Morris, chief medical officer of Inivata, states, “This collaboration is part of our ongoing program to establish the clinical utility of our InVision liquid biopsy platform and to illustrate the clinical challenges it can solve for physicians.”
Based on research from the Rosenfeld Lab at the Cancer Research UK Cambridge Institute, the InVision liquid biopsy platform combines sensitivity with a select multigene panel to provide clinically actionable information to clinicians.

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