New blood test shows promise in cancer fight

New blood test shows promise in cancer fight

6:40 AM, 21st April 2015
New blood test shows promise in cancer fight
When doctors got a clean blood DNA test from MarySusan Sabini, they were afraid to rely on it because the test was so new. (C) The New York Times

NEW YORK, US: In the usual cancer biopsy, a surgeon cuts out a piece of the patient’s tumor, but researchers in labs across the country are now testing a potentially transformative innovation. They call it the liquid biopsy, and it is a blood test that has only recently become feasible with the latest exquisitely sensitive techniques. It is showing promise in finding tiny snippets of cancer DNA in a patient’s blood.

The hope is that a simple blood draw — far less onerous for patients than a traditional biopsy or a CT scan — will enable oncologists to quickly figure out whether a treatment is working and, if it is, to continue monitoring the treatment in case the cancer develops resistance. Failing treatments could be abandoned quickly, sparing patients grueling side effects and allowing doctors to try alternatives.

“This could change forever the way we follow up not only response to treatments but also the emergence of resistance, and down the line could even be used for really early diagnosis,” said Dr Jose Baselga, physician in chief and chief medical officer at Memorial Sloan Kettering Cancer Center.

Researchers caution that more evaluations of the test’s accuracy and reliability are needed. So far, there have been only small studies in particular cancers, including lung, colon and blood cancer. But early results are encouraging. A National Cancer Institute study published this month in The Lancet Oncology, involving the most common form of lymphoma, found the test predicted recurrences more than three months before they were noticeable on CT scans.

Oncologists who are not using the new test say they are looking on with fascination. “Our lab doesn’t do it, but we are very interested,” said Dr Levi Garraway of the Dana-Farber Cancer Institute.

Researchers are finding out things about individuals’ cancers that astonish them. MarySusan Sabini, a fifth-grade teacher from Gardiner, NY, has lung cancer that resisted two attempts at chemotherapy and a round of radiation. Her doctors at Sloan Kettering saw cancer DNA in her blood when she began taking an experimental drug in October that was her last hope.

Four days later, the cancer DNA shards had vanished, a sign, the doctors hoped that the treatment was working. The blood test itself was so new that the doctors were afraid to rely on it.

Within weeks, Ms Sabini began to breathe easier. Months later, she had a CT scan, which confirmed her tumors were shrinking. “Every cancer has a mutation that can be followed with this method,” said Dr David Hyman, the oncologist at Sloan Kettering who is leading the study of the experimental drug Ms Sabini takes. “It is like bar coding the cancer in the blood.”

Patients often have scans to determine if tumors are shrinking, but it can take weeks or months before a tumor looks smaller on a scan. Doctors can be fooled into thinking a tumor is present when, in fact, it is gone.

“When you are treating a patient — and we see this many times — your treatment is quite effective but there is some residual lesion on a scan,” Dr Hyman said. “You take the patient to surgery for a biopsy, and all you see is scar tissue. There is no visible cancer there.”

The blood tests also allow frequent monitoring of tumors as they spread and mutate or develop resistance to treatment. The only other way to know is with biopsies. “I cannot do a weekly liver biopsy and see how things are going,” said Dr Baselga. “But I can do a blood test every week.”

Two Australian scientists, working with Dr Bert Vogelstein of Johns Hopkins, wondered if a cancer DNA blood test might be predictive. They began with a study of 250 patients, looking for cancer DNA in blood after surgery. The tumors recurred in 80 percent of those with cancer DNA in their blood but only 6 to 8 percent of those whose blood did not have detectable cancer DNA.

Now the Australian researchers, Dr Jeanne Tie and Dr Peter Gibbs of the Walter and Eliza Hall Institute of Medical Research, are starting a study of 450 patients randomly assigned to have the blood test or not. Those who have it will get chemotherapy if the test finds cancer DNA. Those who do not have the blood test will get usual care, whatever their physician prescribes.

The patients will be told their blood test results, although the investigators worry how some will react. “If you find DNA and tell the patient there is a very high risk of recurrence, that creates a lot of anxiety,” Dr Gibbs said. “And we are not sure chemotherapy will be helpful.”

The blood test, they hope, will answer that question. “This will be the first real test of whether circulating tumor DNA can be clinically useful,” Dr Vogelstein said.

© The New York Times Company

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