CTOAM Liquid Biopsies Clinical Utility

 

The following list outlines some of the more common liquid biopsy tests and how they can be applied in the clinical setting.

1. PD-1Ligand Testing
Programmed death 1 (PD-1L) is a protein that cancers use to shut down the immune system.
Patients with tumors that have high levels of PD-1L have exceptional responses to receptor and ligand (PD-1R/L) inhibitors.

However, not all tumors will express the PD-1L protein at the same time and the expression of it varies between different tumor sites. Because of this, biopsy based PD-1L testing has been not an accurate predictor to responses to PD-1R/L inhibitors such as nivolumab and pembrolizumab.

As you can imagine, testing all of the body’s tumors at the same time, through the use of a blood test, is much more accurate in determining responses to nivolumab and pembrolizumab and other PD-1R/L inhibitors than testing of a single biopsy sample.
Find out now if this amazing new class of drugs with minimal side effects are an option for you.

COST = $1750.96 Can Plus GST

2. EML4-ALK Testing
One alteration common to lung and brain cancers is called EML4-ALK, often referred to as ALK fusions. Patients with the EML4-ALK, or another mutation called ROS1, have a significantly longer survival when given a new drug called crizotinib. Furthermore, once crizotinib stops working, they can now go on the next generation drug, cabozantinib or alectinib.

A recent study of alectinib in patients with crizotinib-refractory ALK-positive NSCLC (lung cancer), including 61% with CNS (brain) metastases, resulted in significant response rates with minimal grade 3 and 4 adverse events (side effects).
Find out now if this amazing new class of drugs with minimal side effects are an option for you.

COST = $1539.62 Can Plus GST

3. ROS1 Testing
ROS1 fusions mutations occur in lung cancers, cholangiocarcinomas (bile duct cancers) and glioblastoma multiforme (GBM), a type of brain cancer. Like ALK fusions, tumors with ROS1 fusions are associated with strong sensitivity to crizotinib and next generation drugs such as cabozantinib.

Since some drugs that target ALK fusions work on ROS1 fusions, this test can be considered as a companion test for ALK-fusions.
Find out now if this amazing new class of drugs with minimal side effects are an option for you.

COST = $3117.10 Can Plus GST

4. AR-V7 Testing
Androgen-Receptor Splice Variant 7 (AR-V7) in metastatic castration-resistant prostate cancer (mCRPC) predicts resistance to treatment with either enzalutamide or abiraterone androgen therapy.

However in these same patients, the AR-V7 alteration predicts sensitivity to taxane chemotherapy. Recent data shows that if a mCRPC cancer patient is AR-V7 positive, their chance of progression on taxane chemotherapy is approximately 79 % lower than on an androgen directed therapy.

In other words, there is a 4.8-fold greater risk of progression for AR-V7-positive patients who receive androgen therapy(abiraterone or enzalutamide) instead of taxane chemotherapy.
Find out now if your androgen therapy is working or not, way before your tumors get a chance to metastasize!

COST = $1750.96 Can Plus GST

5. ESR1 Testing
Estrogen receptor one (ESR1) mutations in patients with ER-positive metastatic breast cancer result in resistance to anti-estrogen therapy.

This test will tell you if you are resistant to anti-estrogen therapy and if a change in your medication is needed well before your tumors metastasize.

COST = $2900.00 Can Plus GST

6. EGFR Testing
EGFR activating mutations are found in a variety of cancers including lung cancers. EGFR mutations indicate sensitivity to first and second generation EGFR inhibitors such as erlotinib, gefitinib and afatinib. Furthermore, the type of EGFR mutation can help determine what EGFR drug is best for that specific person.

Typically, patients stop responding to the first and second generation EGFR inhibitors due to a new mutation called the EGFR T790M gatekeeper mutation.

However, newer EGFR inhibitors have shown significant benefits for patients with this mutation.
For example, Rocelitinib has shown a 59% response rate and AZ9291 a 61% response rate in T790M-mutated NSCLC patients that are resistant to first and second generation EGFR inhibitors.
Find out now if this amazing new class of drugs with minimal side effects are an option for you.

COST = $2382.56 Can Plus GST

7. KRAS Testing
Studies have shown that KRAS mutations are involved in secondary resistance to anti-EGFR therapies in colorectal cancers and resistance to erlotinib and gefitinib in NSCLC.

This test will tell you if you are resistant to anti-EGFR therapy and if a change in your medication is needed well before your tumors metastasize.

COST = $1750.96 Can Plus GST

8. NRAS Testing
NRAS mutation status has been associated with resistance to anti-EGFR therapy in colorectal cancer as well as for BRAF inhibitor response in metastatic melanoma patients. This test will let you know if you are resistant to anti EGFR therapy or BRAF inhibitors.

This test will tell you if you are resistant to anti-EGFR or BRAF therapy and if a change in your medication is needed well before your tumors metastasize.

COST = $1621.77 Can Plus GST

9. BRAF Testing
BRAF mutations are found in many types of cancers including brain, melanoma and these cancers respond well with BRAF inhibitors. However, BRAF mutations in colon cancer indicate that the standard therapies as well as EGFR targeted drugs will not be as effective, and combinations that include BRAF inhibitors can help increase survival rates.

This test will tell you if BRAF inhibitors such as vemurafenib can play a part in your treatment and if a change in your medication is needed well before your tumors metastasize.

COST = $1750.96 Can Plus GST