Liquid biopsies for colorectal cancer: a narrative review of ongoing clinical trials and the current use of this technology at a comprehensive cancer center

Abstract

Objective: In this review, we summarize ongoing clinical trials involving liquid biopsies (LB) for colorectal cancer (CRC), outlining the current landscape and the future implementation of this technology. We also describe the current use of LB in CRC treatment at our institution, the Mayo Clinic Enterprise.Background: The use of LB in CRC treatment merits close attention. Their role is being evaluated in the screening, non-intervention, intervention, and surveillance settings through many active trials. This, coupled with the technique's rapid integration into clinical practice, creates constant evolution of care.Methods: Review of ClinicalTrials.gov was performed identifying relevant and active trials involving LB for CRC. "Colorectal cancer" plus other terms including "liquid biopsies" and "ctDNA" were used as search terms, identifying 35 active trials.Conclusions: LB use for the CRC is actively being investigated and requires close attention. Based on current evidence, Mayo Clinic Enterprise currently uses LB in the non-interventional, interventional and surveillance setting, but not for screening. Results of these trials may further establish the use of LB in the management of CRC.

Evaluation of the cell-free DNA integrity index as a liquid biopsy marker to differentiate hepatocellular carcinoma from chronic liver disease

“…Now multimodal liquid biopsy-based test (LUNAR-2 or Shield Test) is on trial and showing promising results for early detection of CRC. This test includes ctDNA assessment of somatic mutations, tumor-derived methylation, and cfDNA fragmentations ( Broccard et al, 2022 ). The ctDNAs are small fraction of cfDNA that mainly derived from primary tumors, metastatic tumors, and CTCs.…”

PD-1 blockade plus chemoradiotherapy as preoperative therapy for patients with BRPC/LAPC: A biomolecular exploratory, phase II trial

“…A large sample analysis has demonstrated that ctDNA may be a feasible biomarker for various solid tumor types. 38 Moreover, ctDNA could provide longitudinal and dynamic surveillance of the tumor-specific genetic characteristics without having to repeatedly perform invasive tumor biopsies that cost more time and money. 39 In our study, serial ctDNA dynamic changes in predicting tumor responses and survival outcomes revealed that patients with a >50% decline in maxVAF between the first clinical evaluation and baseline had longer survival outcomes and higher response rates than those who did not.…”

Warning signs from the crypt: Aberrant protein glycosylation marks opportunities for early colorectal cancer detection.

“…Liquid biopsy is a novel category aiming to detect circulating cancer, including circulating tumor cells, circulating tumor DNA, and cell-free DNA ( 6 ). Currently, there are 35 liquid biopsy CRC trials ongoing to help establish their clinical utility ( 7 ); however, a potential problem is the need for sufficient tumor volume, which challenges its suitability for screening purposes. Developing a blood-based screening test targeting precancerous events would be an appealing approach.…”