Liquid Biopsy - Ideas?

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hopeinGod2
Posts: 7
Joined: Wed Dec 05, 2018 9:52 pm
Facebook Username: barbara.jamison

Liquid Biopsy - Ideas?

Postby hopeinGod2 » Wed Jun 08, 2022 3:01 pm

Considering a liquid biopsy. Have heard about Biocept, Guardant, Signatera and a couple of others.
Orig tumor path report says negative for Lynch and it is MSS, if that helps.

Thoughts?
12/17 C-scopy - "3 cm distal rectal mass"
11/18 TAE
Adenocarcinoma RC
Mod diff
Stage 1, PT2
T2N0M0
CEA 11/18 <.5; 11/19 1.9; 5/20: 1.5; 2/22: .7

12/18 Biopsies NED
2-3/19 MRI / C-scopy- NED
3/19 PET Lung RM node 6mm
4-5/19 Chemo radiation
7/19 MRI - NED
7/19 Colonoscopy - benign polyp removed
7-11/19 CAPOX
12/19, 7/20, 1/21, 1/22- Scopes/MRIs NED
6/20 CT NED
2/21 CT 3 mm nodule LU lobe
2/22 CT 1.4cm nodule RM lobe
3/22 PET RML 12 x 11mm, 2.8 SUV
4/22 Biopsy benign, BUT surgery rec.

MadMed
Posts: 166
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Liquid Biopsy - Ideas?

Postby MadMed » Wed Jun 08, 2022 4:39 pm

This is my understanding of it.if we’re talking about the same thing. Liquid biopsy is not as accurate as sending actual biopsy tissue.

I get signatera tests quarterly. The process starts with sending a biopsy (tissue or blood draw) then after surgery, you send a blood draw and they try to see if there’s any cancer cells that are in the blood from that particular tumor. That’s what they call MRD, molecular residual disease.

If you send them tissue at the beginning, the results are more “specific”, meaning positive means recurrence at some point.
If you send a liquid biopsy, it’s less accurate.

These tests are not 100% on the negative side. Meaning negative does not mean no possible recurrence. From what I read, it’s more like 50%. They are more “correct” on the positive side, if they find it, it’s 80% recurrence within a years or something like that.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

MadMed
Posts: 166
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Liquid Biopsy - Ideas?

Postby MadMed » Wed Jun 08, 2022 4:43 pm

I should mention, there’s another type of tests, galleri cancer test is an example of that. These panels test for genetic cancer signal. Meaning, they have genetic indicators for certain cancers that they check for.

I had that done and it came back negative, even though I have RC.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

Nycomomohead
Posts: 28
Joined: Sat Oct 30, 2021 7:34 pm

Re: Liquid Biopsy - Ideas?

Postby Nycomomohead » Thu Jun 09, 2022 4:38 am

There was a small study done on Signatera from City of Hope recently.

In general, the takeaway was that reliance on liquid biopsy alone is not recommended, but it can sometimes find things earlier. Google city of hope Signatera for some articles on this small study.
Spouse, DX, 49F - Rectal Stage 1 - T2NOMO - 2CM - 7.8 from AV.
10.29.21 Rectal tumor 2cm, 10cm from AV | colonoscopy
11.01.21 Biospy - Malignant - adenocarcinoma
11.03.21 First consultation with Surgeon & Onc
11.04.21 CBC blood work looked good. CEA at 1.1
11.05.21 CT Scan. Good, no sign of spread. Precautionary Liver MRI scheduled.
11.09.21 MRI Pelvis. MRI Liver.
11.09.21 Staged as Stage 1. T2NOMO - 2CM - 7.8 from AV.

User avatar
Peregrine
Posts: 100
Joined: Tue Mar 01, 2022 1:18 am

Re: Liquid Biopsy - Ideas?

Postby Peregrine » Thu Jun 09, 2022 9:54 am

Nycomomohead wrote:There was a small study done on Signatera from City of Hope recently.

In general, the takeaway was that reliance on liquid biopsy alone is not recommended, but it can sometimes find things earlier. Google city of hope Signatera for some articles on this small study.

Thanks for the tip ! Here is what I found by googling:

    City of Hope Researcher Advises Doctors Against Overreliance on a Popular Liquid Biopsy Used to Screen for Colorectal Cancer Recurrence
    “A liquid biopsy measuring circulating tumor DNA is a novel way to test for residual disease in patients who have recently received curative resection for colon cancer. Identifying early disease recurrence is important as it may allow for potential curative interventions,” said Marwan Fakih, M.D., co-director of City of Hope’s Gastrointestinal Cancer Program and lead author of the new study.

    City of Hope researchers evaluated 48 study participants who had had their colorectal cancer resected. The scientists sought to identify which technique might be superior in identifying residual disease and early cancer recurrence by comparing the use of Signatera’s circulating tumor DNA (ctDNA) analysis, which is often used to screen for colorectal cancer, to the standard-of-care recommended by the National Comprehensive Cancer Network (NCCN): X-rays via computed tomography (CT) scan and a carcinoembryonic antigen (CEA) test, which measures a tumor marker via a blood draw.

    Fifteen patients experienced colorectal cancer recurrence. Within this group, standard-of-care surveillance was better at identifying early disease. For example, Signatera did not identify patients who had early recurrence in the lungs. Three patients received a negative ctDNA test, but standard-of-care surveillance techniques identified disease recurrence in their lungs.

    “Imaging remains the most important surveillance assay in the follow-up of resected colorectal cancers. Clinicians should continue to abide by NCCN guidelines. For those who decide to implement ctDNA into their surveillance algorithm, they should be aware of the limitations associated with this assay,” Fakih said, referencing current clinical trials elsewhere where clinicians are de-intensifying chemotherapy based on a negative ctDNA test by Signatera.

    It may be premature to base treatment decisions solely on ctDNA results “given the limitations of Singatera sensitivity,” said Fakih, the Judy & Bernard Briskin Distinguished Director of Clinical Research and a professor in City of Hope’s Department of Medical Oncology & Therapeutics Research.

    Fakih added that using liquid biopsies to identify disease recurrence is an attractive, noninvasive option. Liquid biopsy is convenient and, unlike CT, does not expose patients to low doses of radiation. However, scientists are still working to develop a reliable and sensitive liquid biopsy to detect colorectal cancer recurrence. Nevertheless, there is promise.

    ctDNA was able to identify several recurrences in the liver and lymph nodes ahead of imaging,” Fakih said. “For now, ctDNA can be considered, if any at all, as a complement to the standard approach recommended by the NCCN, but one must be cognizant of its limitations.”


    Reference: https://www.biospace.com/article/releases/city-of-hope-researcher-advises-doctors-against-overreliance-on-a-popular-liquid-biopsy-used-to-screen-for-colorectal-cancer-recurrence/ March 8, 2022

MadMed
Posts: 166
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Liquid Biopsy - Ideas?

Postby MadMed » Thu Jun 09, 2022 10:13 am

Great post Peregrine, thank you. This is exactly how i use Signatera, as an add-on. My scans (MRI + CT C/A/P) were every 4 months , i recently changed my CT to be offset by 2 months from the MRI, this gives me a 2 month window. Signatera is to catch something in the middle of the 2 months or something too small to detect yet.

Dropping regular checks just for Signatera would be foolish. It's not there yet, and may never get there. My CEA is also not useful in my case, when the tumor was full blown, my CEA was 1.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

Nycomomohead
Posts: 28
Joined: Sat Oct 30, 2021 7:34 pm

Re: Liquid Biopsy - Ideas?

Postby Nycomomohead » Thu Jun 09, 2022 2:22 pm

Madman,

Do you ask for results of your Signatera from Netera or do you ask for readout from your Oncologist?
Spouse, DX, 49F - Rectal Stage 1 - T2NOMO - 2CM - 7.8 from AV.
10.29.21 Rectal tumor 2cm, 10cm from AV | colonoscopy
11.01.21 Biospy - Malignant - adenocarcinoma
11.03.21 First consultation with Surgeon & Onc
11.04.21 CBC blood work looked good. CEA at 1.1
11.05.21 CT Scan. Good, no sign of spread. Precautionary Liver MRI scheduled.
11.09.21 MRI Pelvis. MRI Liver.
11.09.21 Staged as Stage 1. T2NOMO - 2CM - 7.8 from AV.

MadMed
Posts: 166
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Liquid Biopsy - Ideas?

Postby MadMed » Thu Jun 09, 2022 6:40 pm

It goes through the oncologist’s office. I have the blood draw when I get my port flushed, so it works out well.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

User avatar
Peregrine
Posts: 100
Joined: Tue Mar 01, 2022 1:18 am

Re: Liquid Biopsy - Ideas?

Postby Peregrine » Thu Jun 09, 2022 11:41 pm

hopeinGod2 wrote:Considering a liquid biopsy. Have heard about Biocept, Guardant, Signatera and a couple of others.
Orig tumor path report says negative for Lynch and it is MSS, if that helps.

Thoughts?

hopeinGod2 -

Thanks for posting this and for giving the names of the three products.

I do have some thoughts on the matter, but I have not done enough research yet to be able to draft a good overview.

However, what I would suggest, first, is for you to review the 14 posts in the thread below, because some of the comments there are very relevant to your question.

Also, here are some links to the websites for the four products mentioned so far in the current thread. These are listed in alphabetical order:



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