Liquid Biopsy and Therapeutic Targets: Present and Future Issues in Thoracic Oncology

Abstract

The practice of liquid biopsy (LB) has revolutionized the care of patients with metastatic lung cancer. Many oncologists now use this approach in daily practice, applying precise procedures for the detection of activating or resistance mutations in EGFR. These tests are performed with plasma DNA and have been approved as companion diagnostic test for patients treated with tyrosine kinase inhibitors. ALK is another important target in lung cancer since it leads to treatment of patients who are positive for a rearrangement in ALK identified with tumor tissue. By analogy with EGFR, LB for detection of genomic alterations in ALK (rearrangements or mutations) has been rapidly adopted in the clinic. However, this promising approach has some limitations and has not yet been disseminated as much as the blood test targeting EGFR. In addition to these two therapeutic targets LB can be used for evaluation of the genomic status of other genes of interest of patients with lung cancer (ROS1, RET, NTRK MET, BRAF, HER2, etc.). LB can be performed to evaluate a specific target or for a more or less complex panel of genes. Considering the number of potential targets for clinical trials, techniques of next-generation sequencing of circulating DNA are on the rise. This review will provide an update on the contribution of LB to care of patients with metastatic lung cancer, including the present limits of this approach, and will consider certain perspectives.

In‐Depth Proteomic Analysis of Human Bronchoalveolar Lavage Fluid toward the Biomarker Discovery for Lung Cancers

“…Currently, biomarker detection using body fluids such as blood, urine, and saliva has emerged as a promising modality for cancer diagnosis and treatment monitoring mainly because of its minimal invasiveness and easy accessibility. [6] Bronchoalveolar lavage fluid (BALF), liquid obtained from the one or more segmental bronchus of interest during bronchoalveolar lavage, has been also considered as the useful body fluid for lung cancer biomarker discovery. BALF is collected during routine flexible bronchoscopy and has gained widespread acceptance as a safe, and minimally invasive method.…”

“…To overcome the limitation and to complement current lung cancer screening, it is essential to discover potential lung cancer biomarkers. Currently, biomarker detection using body fluids such as blood, urine, and saliva has emerged as a promising modality for cancer diagnosis and treatment monitoring mainly because of its minimal invasiveness and easy accessibility . Bronchoalveolar lavage fluid (BALF), liquid obtained from the one or more segmental bronchus of interest during bronchoalveolar lavage, has been also considered as the useful body fluid for lung cancer biomarker discovery.…”

Review article: systemic treatment of hepatocellular carcinoma

“…Liquid biopsy could become an alternative to tissue biomarkers as it may provide an even more comprehensive profile of the cancer than that derived from small tumour specimens . However, unlike in other solid tumours such as lung cancer, liquid biopsy is not yet ready for clinical use in HCC, since large‐scale studies using standardised techniques and uniform methodology are lacking . It also remains unclear if liquid biopsy can adequately reflect the immune tumour microenvironment.…”

Predictive molecular pathology in non–small cell lung cancer in France: The past, the present and the perspectives

“…46 In addition to EGFR testing, blood tests are being progressively developed to look for rearrangements in genes such as ALK and ROS1 in naïve-treated NSCLC patients. 47 Moreover, different genomic alterations (ALK and ROS1 mutation, MET amplification) associated with therapeutic resistance can be looked for in plasma samples on tumor progression. 47 Because many molecular targets can be assessed for several genes, NGS tools are being developed more and more with blood samples.…”

“…47 Moreover, different genomic alterations (ALK and ROS1 mutation, MET amplification) associated with therapeutic resistance can be looked for in plasma samples on tumor progression. 47 Because many molecular targets can be assessed for several genes, NGS tools are being developed more and more with blood samples. 48,49 However, in the absence of current national and international guidelines, a certain number of MGCC do not yet perform these NGS analyses using circulating nucleic acids.…”