Clinical OMICS

NOV-DEC 2018

Healthcare magazine for research scientists, labs, pathologists, hospitals, cancer centers, physicians and biopharma companies providing news articles, expert interviews and videos about molecular diagnostics in precision medicine

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www.clinicalomics.com November/December 2018 Clinical OMICs 21 Marsden Hospital in the U.K., and Lawson Health Research Institute in Canada showed that they could use a character- istic of CTCs to predict the optimal treatment for patients with advanced prostate cancer. The blinded, four-year study utilized the Oncotype DX AR-V7 Nucleus Detect test to determine if the nuclei from CTCs taken from 142 cas- tration-resistant prostate cancer patients contained a pro- tein called AR-V7. It is one of the first tests to validate the predictive value of a liquid biopsy for therapeutic response and demonstrated survival benefit. The researchers found that patients who had this variant present in the nucleus lived longer when treated with taxane-based chemotherapy, while those who tested negative for nucleic AR-V7 lived longer when treated with hormone-targeting therapy using androgen-receptor signaling (ARS) inhibitors. "The importance of this treatment decision cannot be understated," said Ryan Dittamore, chief of medical innova- tion and head of translational research partnerships for Epic Science, the company that offers the test for nucleic AR-V7 in partnership with Genomic Health. The test results are available to physicians in less than one week, an improve- ment over ctDNA tests that can take two to three weeks. Because these patients deteriorate rapidly, and weeks-long delays can be detrimental to the chances of survival, the days saved via the test can be vital in providing appropri- ate treatment, Dittamore explained. In the current study, researchers also validated the test across patient risks, to ensure the biomarker effect was due to the biomarker rather than other clinical variables. "We now have independent validation that the test is more predictive than physician intuition alone, meaning the test can help to extend the life of patients," he concluded. Meanwhile, the search is on for biomarkers like AR-V7 in all cancer types as scientists continue to make discoveries about the clinical significance of the number of CTCs pres- ent in a patient's blood. Anthony Lucci, M.D., a professor of breast surgical oncology at MD Anderson Cancer Cen- ter, has shown that CTCs have prognostic value and that what scientists are learning in one type of cancer informs CTC-based work in others. In 2015, Lucci and his colleagues published a prospective study in the Journal of the National Cancer Institute that showed that the presence of even one CTC in patients with stage III inflammatory breast can- cer—a rare and aggressive form of the disease—after pri- mary chemotherapy were at high risk for relapse. In 2016, he and his colleagues showed in another prospective study that one or more CTCs at baseline were associated with progres- sion within 180 days in stage IV melanoma patients. When (continued on next page) Olga Efimova / EyeEm / Getty Images Epic Science's digital pathology software analyzes image files for a multi- tude of immunofluorescent and morphological features on an estimated three million cells per slide.

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