Expert Highlights Need for Widespread Liquid Biopsy Use in Lung Cancer Treatment

Alain Borczuk, MD

Liquid biopsies are found to be effective in the detection of lung cancer and potential biomarkers; however, there needs to be further integration with liquid biopsies into the pathology realm of cancer care, according to Alain Borczuk, MD. Pathologists should have more of a role in the coordination of such assays so they can incorporate the results into their everyday practice, he explained.

Currently, there is one FDA-approved blood-based assay that is designed to detect EGFR mutations in patients with non—small cell lung cancer. With liquid biopsies, physicians have the opportunity to detect more biomarkers and extend the ability to utilize tissue samples. However, more research needs to be conducted to find and categorize more potential biomarkers in patients with lung cancer—an area Borczuk believes needs more coordination.

“We need to categorize [biomarkers] so we can group them together and find targeted therapies that might be beneficial to patients,” said Borczuk, a professor of pathology and laboratory medicine at Weill Cornell Medicine/NewYork-Presbyterian Hospital.

In an interview with OncLive, Borczuk discussed the recent advancements in lung cancer treatment, the evolving field, and the future potential for liquid biopsies.

OncLive: With the recent advancements in lung cancer, how have your conversations with oncologists and surgeons changed?

Borczuk: As pathologists, we interact with our colleagues, either oncologists or surgeons, who treat patients. The advent of molecular testing in the modern approach for diagnosis means that we're talking about molecular testing and its results at initial tumor boards, and in progressive discussions that we have with oncologists. The patients and their care are not a single stage in diagnosis conversation. It's now an ongoing conversation about repeat molecular testing and ultimately new treatments as they come along.

What are the key points the community should know about limiting issues in lung cancer?

When discussing limiting tissues in pathology and oncology, it is important is that we interact with the oncologists and surgeons because they are the operators. We also need to include interventional radiologists, who are the operators that give us the material we need to test. We need to make sure the interventional radiologists know how a sample adequate for testing looks so that they can provide it. They need feedback to know when the samples are not adequate; that is a huge problem that has been recognized in the field.

In addition, for pathologists, we need to find mechanisms in which we don't waste the tissue we receive. We recognize it as a precious commodity, not just for diagnosis, but for all the testing that needs to be done today. Additionally, with new discoveries being made so frequently, testing may need to be done in 6 months, 1 year, or 3 years.

What is the role of liquid biopsies?

The role of liquid biopsies is still to be defined. It has its own profile in terms of sensitivity, especially of the test. In the role liquid biopsies has now, it potentially extends the ability to use the tissue. Certain alterations may be found in liquid biopsies, but right now I can only focus on the alterations that can be determined by tissue.

Liquid biopsies have a huge role, but the issue for pathologists is that we often are not coordinated with the liquid biopsy test. It's being done by labs and clinicians without our knowledge. As a result, we can't integrate that into our algorithm because we're not aware of the result. That needs to change.

What can be accomplished in the upcoming years for liquid biopsies?

The categorization of the tumors in a comprehensive way needs to occur because all tumors, including lung cancer, will have patients with alterations that have yet to be fully defined. [Defining alterations] is still an ongoing process and we need to do it in a more coordinated way so we can have the data that we need to truly find which alteration is best for that patient. This is not an exercise of hundreds or thousands of patients, but as we've seen in breast cancer, we need 10,000 to 100,000 patients to truly accomplish this. This has to be a nationwide coordinated effort.