Early Detection of Cancers in the Era of Precision Oncology

Tan, Wan Ying; Sharma, Anup; Das, Paromita; Ahuja, Nita

doi:10.1097/cco.0000000000000931

Cited by 3 publications

(2 citation statements)

References 71 publications

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“…In addition, clinically feasible, safe, and cost-effective testing needs to be made available [91]. Liquid biopsy, a blood-based analysis of circulating tumor DNA (ctDNA), has emerged as a prominent noninvasive procedure with minimal risk of complications compared to conventional tissue biopsies [92].…”

Section: Epigenetics-based Biomarkers For Monitoring Surveillance And...mentioning

confidence: 99%

The Promise of Epigenetics Research in the Treatment of Appendiceal Neoplasms

Ladel,

Tan,

Jeyakanthan

et al. 2023

Cells

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Appendiceal cancers (AC) are a rare and heterogeneous group of malignancies. Historically, appendiceal neoplasms have been grouped with colorectal cancers (CRC), and treatment strategies have been modeled after CRC management guidelines due to their structural similarities and anatomical proximity. However, the two have marked differences in biological behavior and treatment response, and evidence suggests significant discrepancies in their respective genetic profiles. In addition, while the WHO classification for appendiceal cancers is currently based on traditional histopathological criteria, studies have demonstrated that histomorphology does not correlate with survival or treatment response in AC. Due to their rarity, appendiceal cancers have not been studied as extensively as other gastrointestinal cancers. However, their incidence has been increasing steadily over the past decade, making it crucial to identify new and more effective strategies for detection and treatment. Recent efforts to map and understand the molecular landscape of appendiceal cancers have unearthed a wealth of information that has made it evident that appendiceal cancers possess a unique molecular profile, distinct from other gastrointestinal cancers. This review focuses on the epigenetic landscape of epithelial appendiceal cancers and aims to provide a comprehensive overview of the current state of knowledge of epigenetic changes across different appendiceal cancer subtypes, highlighting the challenges as well as the promise of employing epigenetics in the quest for the detection of biomarkers, therapeutic targets, surveillance markers, and predictors of treatment response and survival in epithelial appendiceal neoplasms.

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Section: Epigenetics-based Biomarkers For Monitoring Surveillance And...mentioning

confidence: 99%

The Promise of Epigenetics Research in the Treatment of Appendiceal Neoplasms

Ladel,

Tan,

Jeyakanthan

et al. 2023

Cells

Self Cite

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“…Advanced cancer genome-wide sequencing has discovered that each individual cancer evolves to become unique and complex, such that better outcomes are achieved when treatments are personalised to each individual cancer rather than delivered empirically (Walton et al, 2022 ; Hofmarcher et al, 2023b ; Horgan et al, 2023 ; Tan et al, 2023 ). This level of functional complexity in cancer means that simple stratification at the standard of care level must be converted to the true and rare subtype personalisation requiring integrated solutions across regional and national populations.…”

Section: Introductionmentioning

confidence: 99%

Challenges and solutions to system-wide use of precision oncology as the standard of care paradigm

Lajmi,

Alves-Vasconcelos,

Tsiachristas

et al. 2024

Camb. prisms Precis. med.

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The personalised oncology paradigm remains challenging to deliver despite technological advances in genomics-based identification of actionable variants combined with the increasing focus of drug development on these specific targets. To ensure we continue to build concerted momentum to improve outcomes across all cancer types, financial, technological and operational barriers need to be addressed. For example, complete integration and certification of the ‘molecular tumour board’ into ‘standard of care’ ensures a unified clinical decision pathway that both counteracts fragmentation and is the cornerstone of evidence-based delivery inside and outside of a research setting. Generally, integrated delivery has been restricted to specific (common) cancer types either within major cancer centres or small regional networks. Here, we focus on solutions in real-world integration of genomics, pathology, surgery, oncological treatments, data from clinical source systems and analysis of whole-body imaging as digital data that can facilitate cost-effectiveness analysis, clinical trial recruitment, and outcome assessment. This urgent imperative for cancer also extends across the early diagnosis and adjuvant treatment interventions, individualised cancer vaccines, immune cell therapies, personalised synthetic lethal therapeutics and cancer screening and prevention. Oncology care systems worldwide require proactive step-changes in solutions that include inter-operative digital working that can solve patient centred challenges to ensure inclusive, quality, sustainable, fair and cost-effective adoption and efficient delivery. Here we highlight workforce, technical, clinical, regulatory and economic challenges that prevent the implementation of precision oncology at scale, and offer a systematic roadmap of integrated solutions for standard of care based on minimal essential digital tools. These include unified decision support tools, quality control, data flows within an ethical and legal data framework, training and certification, monitoring and feedback. Bridging the technical, operational, regulatory and economic gaps demands the joint actions from public and industry stakeholders across national and global boundaries.

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Translation of Epigenetics in Cell-Free DNA Liquid Biopsy Technology and Precision Oncology

Tan,

Nagabhyrava,

Ang-Olson

et al. 2024

CIMB

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Technological advancements in cell-free DNA (cfDNA) liquid biopsy have triggered exponential growth in numerous clinical applications. While cfDNA-based liquid biopsy has made significant strides in personalizing cancer treatment, the exploration and translation of epigenetics in liquid biopsy to clinical practice is still nascent. This comprehensive review seeks to provide a broad yet in-depth narrative of the present status of epigenetics in cfDNA liquid biopsy and its associated challenges. It highlights the potential of epigenetics in cfDNA liquid biopsy technologies with the hopes of enhancing its clinical translation. The momentum of cfDNA liquid biopsy technologies in recent years has propelled epigenetics to the forefront of molecular biology. We have only begun to reveal the true potential of epigenetics in both our understanding of disease and leveraging epigenetics in the diagnostic and therapeutic domains. Recent clinical applications of epigenetics-based cfDNA liquid biopsy revolve around DNA methylation in screening and early cancer detection, leading to the development of multi-cancer early detection tests and the capability to pinpoint tissues of origin. The clinical application of epigenetics in cfDNA liquid biopsy in minimal residual disease, monitoring, and surveillance are at their initial stages. A notable advancement in fragmentation patterns analysis has created a new avenue for epigenetic biomarkers. However, the widespread application of cfDNA liquid biopsy has many challenges, including biomarker sensitivity, specificity, logistics including infrastructure and personnel, data processing, handling, results interpretation, accessibility, and cost effectiveness. Exploring and translating epigenetics in cfDNA liquid biopsy technology can transform our understanding and perception of cancer prevention and management. cfDNA liquid biopsy has great potential in precision oncology to revolutionize conventional ways of early cancer detection, monitoring residual disease, treatment response, surveillance, and drug development. Adapting the implementation of liquid biopsy workflow to the local policy worldwide and developing point-of-care testing holds great potential to overcome global cancer disparity and improve cancer outcomes.

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Early Detection of Cancers in the Era of Precision Oncology

Cited by 3 publications

References 71 publications

The Promise of Epigenetics Research in the Treatment of Appendiceal Neoplasms

The Promise of Epigenetics Research in the Treatment of Appendiceal Neoplasms

Challenges and solutions to system-wide use of precision oncology as the standard of care paradigm

Translation of Epigenetics in Cell-Free DNA Liquid Biopsy Technology and Precision Oncology

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