Monitoring cancer patients and assessing their response to treatment can sometimes involve invasive procedures, including surgery.
A new experimental technique may help change that.
Researchers from Cedars-Sinai Medical Center and the University of California, Los Angeles (UCLA), are using a small device to help predict which cancers are likely to spread.
The experimental device is about the size of a postage stamp. The NanoVelcro Chip has nanowires 1,000 times thinner than a human hair.
The chip is coated with proteins that recognize circulating tumor cells. These are cells that have broken off from tumors and entered the bloodstream.
From there, cancer cells can travel throughout the body and spread to other tissues and organs.
The researchers run the blood sample through the chip. The proteins recognize and capture circulating tumor cells, which can then be identified and analyzed.
It’s a technique that could make monitoring cancer treatment easier.
“It’s far better to draw a tube of blood once a month to monitor cancer than to make patients undergo repeated surgical procedures,” Dr. Edwin Posadas said in a press release.
Posadas is medical director of the Urologic Oncology Program at Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, and one of the lead investigators of the research.
“The power of this technology lies in its capacity to provide information that is equal to, or even superior to, traditional tumor sampling by invasive procedures,” he continued.
Blood biopsies for prostate cancer
The research focused on prostate cancer.
It’s an important area of study because prostate cancer can be slow growing or super aggressive.
Slow-growing types may never become an issue and don’t necessarily need treatment. Other types spread quickly and are potentially fatal.
According to the American Cancer Society, prostate cancer is the third leading cause of cancer death in men in the United States.
Knowing the difference as early as possible can save many men from treatment they don’t need. For others, it means getting the most effective treatment as quickly as possible.
This research showed that some cancer cells contain a smaller nucleus than others. Men with the most aggressive type of prostate cancer have cells with these small nuclei.
The scientists found that the smaller nuclei are associated with cancer spreading to the liver and lungs. And it happened before the metastases were found.
It’s a discovery that could help identify those patients who are at high risk of metastatic prostate cancer.
Circulating tumor technology
Liquid biopsies have been around for some time.
So has the concept of circulating tumor cells, according to urologist Dr. Timothy Wilson.
“All solid tumors release circulation tumor cells. Some science suggests even early cancer, or small cancers, release cells into the bloodstream,” he told Healthline.
Wilson is director of the Urologic Oncology Research Program, and professor and chair of urology at the John Wayne Cancer Institute at Providence Saint John’s Health Center in California.
Wilson said that for men with a metastatic prostate cancer, who have a high tumor burden, the biopsies are a valuable tool for tracking how well treatment is working.
Getting the tissue for a tumor biopsy involves an invasive procedure, which often means surgery. The location of the tumor and health status of the patient can sometimes make that risky.
Liquid biopsies are convenient and noninvasive, so they’re easier on patients. And they help doctors choose the treatments with the most potential to work.
“Right now, blood biopsies are not used to detect, but to monitor mostly metastatic cancers. If you’re not getting a good response to treatment, and there’s an increase in cancer cells, you can switch gears and try another treatment,” said Wilson.
Blood biopsies as a screening tool
When doctors want to know if suspicious tissue is cancerous, they generally perform a biopsy of the tumor.
If a tissue biopsy could be replaced with a blood biopsy, it could usher in a new age of diagnosis and treatment for cancer.
We’re not there yet, but Wilson has high hopes for the future.
“The value is exciting if we have good detection for finding evidence in cancer in the bloodstream,” he said. “It would have a huge impact. Imagine what it would mean for screening.”
Wilson said that current screening and monitoring tests are relatively ineffective in finding small amounts of cancer.
Finding cancer in its early phase through these new modalities could eliminate the need for all these other tests.
Theoretically, a blood sample could tell you if you’re cancer free or not. Then you could isolate and identify circulation tumor cells and analyze the DNA to learn where it came from (prostate, breast, etc.).
“That’s where the science is going, but we’re several years away from that,” he said.
It would amount to a lot less testing and big cost savings, said Wilson.
He believes the small chip used by the Cedars-Sinai/UCLA researchers adds to the field of precision medicine.
Wilson said one of the important next steps will be increasing the likelihood of finding smaller numbers of cancer cells when the concentration is less.
“This is the wave of the future. Over time, it will get us away from looking at these cancers by the organ from which they came. We’ll be more precise in delivering treatment based on the characteristics of the cancer found as a result of liquid biopsy. We’ll be able to spare more radical surgery, treat earlier, and prevent more aggressive therapies and side effects,” he said.
Posadas and the other lead investigator, Hsian-Rong Tseng, PhD, professor at the Department of Molecular and Medical Pharmacology in the David Geffen School of Medicine at UCLA, are now part of the Blood Profiling Atlas in Cancer (BloodPAC) Project, a Cancer Moonshot program.
Program participants will share data collected from circulating tumor cells. Posadas and Tseng have been collecting samples from circulating tumor cells for five years.
The hope is that the research will lead to effective, targeted treatments for many types of cancer.