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14 Clinical OMICs May/June 2017 www.clinicalomics.com In the Clinic Study Shows ctDNA Can Detect NSCLC Relapse Months Ahead of Standard Methods Moffitt to Provide Cancer Services at MHS in South Florida A new clinical cancer partnership in South Florida will see the Moffitt Cancer Center provide services for blood and marrow transplant and malignant hema- tology, as well as those related to molec- ular diagnostics, personalized medicine, and hematopathology to Memorial Healthcare System (MHS). "Moffitt and Memorial share similar cultures in that we are both driven by patient-centered care, provide world- class cancer treatment, and are dedi- cated to advancing cancer research," said Alan F. List, M.D., Moffitt CEO and presi- dent. "Memorial and its patients will have increased access to research, personal- ized medicine, and innovation through a distribution of the Moffitt model of care." Under the agreement, Moffitt will employ the physicians and advanced practice professionals to staff the new program at MHS. "This is the first time Moffitt-employed physicians will be practicing outside of the Tampa region and that helps us to further our legisla- tive mandate to serve cancer patients across the state," said Louis B. Harrison, M.D., deputy physician-in-chief and chair of Moffitt's department of radia- Even when detected early, up to half of patients diagnosed with non-small cell lung cancer (NSCLC) experience a relapse of the disease. Despite regular monitor- ing by a physician, asymptomatic relapses may evade detection until the disease has metastasized. In a recent study published by Nature, researchers have demon- strated the utility of ctDNA for detecting relapse in early-stage NSCLC patients. The study used personalized multiplex-PCR panels, provided by genetic test- ing and diagnostics company Natera, to detect and analyze mutations in ctDNA isolated from patients' blood. "In some patients you detect mutations from the ctDNA that you know relate to the primary tumor, and it comes well ahead of a CT scan proving that there has been a recurrence," stated Mariam Jamal-Hanjani, M.D., Ph.D., University College of London (UCL) Cancer Institute. In a subset of 24 patients, physicians identified telltale ctDNA up to 347 days before standard detection methods identified signs of relapse. In addition to alerting physicians of an impending relapse months or even years earlier than current detection methods, circulating biomarkers also allow researchers to track tumor evolution. The results published in the Nature article constitute data from the first 100 patients in a larger, 842-patient, nine-year study called TRACERx (Tracking Cancer Evolution Through Therapy). According to Dr. Jamal-Hanjani, who helped design and implement the TRACERx study under the supervision of Charles Swanton, and oversight of the Cancer Research UK and UCL Cancer Trials Centre, the overarching goal of TRACERx is to identify and correlate intra-tumor heterogeneity with clinically relevant outcomes. Albeit preliminary, results from TRACERx recently published in the New England Journal of Medicine indicate that intra-tumor heterogeneity type— whether the heterogeneity arises from point mutations or chromosomal aberra- tions—may be a strong prognostic indicator for patient relapse and survival. "We showed that if you've got a high level of heterogeneity in copy number alterations you do a lot worse. In fact, you are almost five times more likely to have your cancer come back—or die—within the first two years of being followed up," elab- orated Dr. Jamal-Hanjani. "We never expected to find a prognostic significance of intra-tumor heterogeneity this early on in the study."—Meghaan Ferreira (continued on next page) ctDNA analysis is proving a formidable diagnostic tool in the fight against metastatic NSCLC. CIPhotos / Getty Images London Research Institute of Electron Microscopy