The evidence is growing in other areas
Some applications of liquid biopsy testing are further away from use in routine care but look promising.
Can liquid biopsy testing help clinicians spot treatment resistance or relapse earlier?
Researchers are exploring whether repeat or ‘serial’ ctDNA testing during treatment could help identify genetic changes that make a cancer resistant to treatment. It could also help detect signs of cancer returning, before a patient experiences symptoms or the tumour can be seen on imaging. In both cases this could create opportunities to adjust treatment plans earlier, but more evidence is needed to determine whether acting on these earlier signals actually leads to better outcomes for patients. This is an active area of research, particularly in breast cancer, with studies such as SERENA-6 and TRAK-ER.
Can using liquid biopsies to make treatment decisions actually improve outcomes?
Many people with cancer will need more than one type of treatment, for example having chemotherapy or immunotherapy after surgery, known as adjuvant therapy. However, current tests aren’t precise enough to tell which patients will need this type of treatment and which don’t. By looking for tiny traces of cancer remaining after primary treatment, known as minimal residual disease or MRD, some patients may be able to safely avoid unnecessary treatment. And it may help determine when people need more or different treatment to reduce the risk of their cancer coming back. Research has shown that detecting ctDNA in the blood after surgery is linked to cancer coming back and now studies, including in colorectal and bladder cancer, are investigating whether changing a patient’s treatment based on this can improve their outcomes.
What needs to happen before more patients can benefit?
Before a liquid biopsy test can be introduced into routine care, researchers and health systems need to understand whether it improves patient outcomes, is cost-effective, and can be delivered reliably in practice.
Realising the potential of liquid biopsy tests will depend not only on scientific advances, but also on ensuring health systems are ready to translate innovation into benefits for patients. We need to:
- Understand the research pipeline to support planning and efficient adoption
- Identify where changes to cancer care pathways are needed so the benefits of liquid biopsy testing can be realised, such as stopping testing of tissue samples where appropriate
- Make use of specialist expertise on genomic tumour advisory boards so that test results can be interpreted accurately
- Review real world data to monitor implementation and spot opportunities for improvement
At Cancer Research UK, we’re monitoring developments in the field to understand how liquid biopsy tests may help improve patient outcomes in the years ahead. As new evidence emerges, we’ll work with researchers, health systems and policymakers to ensure these benefits reach the right patients quickly and equitably. If you have any questions on this article or topic area, get in touch with our Strategic Evidence team at [email protected].
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