Luis E. Raez, MD
Plasma- and urine-based assays designed to detect actionable mutations in patients with non–small cell lung cancer (NSCLC) are changing the face of treatment for these patients, according to Luis E. Raez, MD.
The liquid biopsies, he says, provide a more convenient and quicker alternative to the standard tissue biopsy. And, if a target is detected, physicians can line up a number of available therapies to begin treatment.
The emergence of liquid biopsies is not the only notable advance in NSCLC, says Ruiz. The explosion of targeted agents and immunotherapies has drastically enhanced treatment options in the field, and researchers are actively working on identifying more targets to hopefully one day be able to eliminate chemotherapy.
Raez, medical director of Memorial Cancer Institute, Memorial Healthcare System, co-chaired the 2016 OncLive
State of the Science Summit on Advanced Non–Small Cell Lung Cancer, where he lectured on the emerging role of liquid biopsies in lung cancer treatment.
In an interview during the meeting, Raez discussed the significance of liquid biopsies in lung cancer, as well as other breakthroughs and remaining challenges in the field.
OncLive: Please discuss the emergence of liquid biopsies in lung cancer.
: Nowadays, the therapy for lung cancer is based on targets. We have been very lucky in that we don’t give chemotherapy widespread anymore. Now, we target the tumor. The main goal now is to identify a target for a patient’s lung cancer tumor.
In that regard, it is very important to do biopsies. However, the biopsies are not easy, because every time you put in a needle, you cause pneumothorax and discomfort.
That’s why I spoke today about liquid biopsies. We start from the blood or urine, and we can get the same information that we get from the tissue. That is the advantage of the liquid biopsies technology as an alternative to the conservative tissue biopsy. It’s less costly, less painful, and is better for the quality of life of the patients and gives us a lot of information.
There are times where it doesn’t seem that there is enough tissue available.
Yes, that is a very important point. The first biopsy is always the standard because you don’t know what tumor a patient has; you have to put a needle in to see. A lot of times, there is not enough tissue. That is why the liquid biopsies are an alternative; there are numerous times that you can draw blood and give urine samples. That is the benefit of the liquid biopsies compared with tissue.
The other benefit is that the liquid biopsies can be done serially. The only way that I would know that a patient is doing better or worse is by looking at their pictures—measuring the pictures of the patient with CT or PET scans. We try to predict if the patient is getting better or worse based on shrinking or increasing changes in size. Now, liquid biopsies give the possibility to measure how much tumor a patient carries in their blood. If we are successful, we are getting rid of the tumor; if we’re not successful, then there is more of the tumor in their blood. That’s probably more accurate than taking pictures.
For the benefit of the patient, it is also less radiation exposure. When you think of having these CT scans or PET scans, it is associated with a lot of radiation. Liquid biopsies bring the opportunity to do a more sophisticated, scientific tracking of the tumors with less harm for the patients.
As this is becoming more available, what is important for community oncologists to be aware of?
The good thing is that liquid biopsies are already available. The techniques are already FDA approved so they have use commercially. The community oncologists can use the technology.
You are giving the patient the opportunity to find the mutation in the blood or the urine. They could have a less toxic therapy, one that is more effective, and one that can prolong and improve their life. That is why it’s important that the community oncologists engage in the practice to use liquid biopsies more often.
What is most anticipated about the future of this field?
We are very excited, now that we have targeted therapy—this therapy based on markers. We’re very excited that we now have immunotherapy—this idea that your own body gets enhanced to fight the cancer. These are the 2 greatest developments in lung cancer in many years. It makes us very happy.