You may find the transcript here .
Below are a few highlights from last night's chat. Resources may be found at the end of the post.
T1: What is a biomarker and how is it identified?
- T1 A biomarker is a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease.
- T1 A biomarker may be used to see how well the body responds to a treatment for a disease or condition. Also called molecular marker and signature molecule.
- T1 Tumor markers, which are a type of biomarker, have traditionally been proteins or other substances that are made by both normal and cancer cells but at higher amounts by cancer cells.
- T1 Tumor markers provide information about a cancer, such as how aggressive it is, whether it can be treated with a targeted therapy, or whether it is responding to treatment:
- T1 A biomarker can be predictive of treatment response or prognostic for disease course independent of treatment
- basic info on Wikipedia: https://t.co/CfEcQ77LCv.
- T1 Cancer researchers are working to develop new biomarkers that can be used to identify cancer in its early stages, to predict the effectiveness of treatment, and to predict the chance of cancer recurrence.
- T1: In the brain tumor community, biomarkers are how we patients introduce ourselves to each other. No longer do we talk about the types or grades (i.e. stage) of our tumors, we talk about our biomarkers. For reals.
T2: What is biomarker testing used for?
- T2 There are two main types of tumor markers that have different uses in cancer care: circulating tumor markers and tumor tissue markers.
- T2 Molecular biomarker tests are generally of three types of biomarkers: diagnostic, therapeutic, prognostic
- T2 Circulating tumor markers, which can be found in the blood, urine, stool, or other bodily fluids of some patients with cancer, are used, for example, to estimate prognosis and to assess the response to treatment.
- T2: Molecular biomarker testing involves laboratory tests that evaluate and identify the presence, on the surface of a cancer cell for e.g. a protein, or the identification of mutations or other changes in the cancer cell genes
- T2 Tumor tissue markers, which are found in actual tumors, are used to diagnose, stage, and/or classify cancer, to estimate prognosis, and to select an appropriate treatment (e.g., treatment with a targeted therapy)
- T2: In cancer, biomarker testing is analysis of DNA, RNA, or proteins that provide info about the diagnosis, prognosis, or are predictive for response to treatment
- T2 An example of a diagnostic biomarker is prostate-specific antigen (PSA) used for screening of prostate cancer. An example of a therapeutic biomarker is EGFR gene testing in patients with lung cancer.
- While the traditional breast carcinoma prognostic markers ER, PR, Her 2 neu predicts whether a patient will need hormonal therapy or chemotherapy or Herceptin, more recently in April 2019, immunotherapy has been approved by FDA in triple negative breast ca patients
- Many non-small cell #lungcancer people also identify with biomarkers--EGFR, ALK, ROS1, BRAF, NTRK, KRAS, RET ....
- T2: Diagnostic biomarkers help in the diagnosis of the cancer itself; therapeutic biomarkers help in determining whether or not a patient might respond to a molecular therapy; and prognostic biomarkers help determine the patient’s chances for long-term survival.
- T2: Here's an overview of what is being studied for #ovariancancer Diagnostic and Prognostic Biomarkers in ovarian cancer and the potential roles of cancer stem cells – An updated review https://t.co/Lo7npjtVOw
T3: What treatment options can be identified through biomarker testing?
- T3 A number of tumor markers are currently being used for a wide range of cancer types. Here’s a list of tumor markers in common use: https://t.co/NtPLX1lStR
- T3 In breast cancer, testing tumors for estrogen and progesterone receptors and the HER2 protein can help doctors help determine whether treatment with hormone therapy or some targeted therapies is appropriate.
- T3 In non-small cell lung cancer, an analysis of mutations in the EGFR gene can help doctors determine a patient’s treatment and estimate prognosis.
- T3: identifying #NTRK fusion in #glioma (est 1% of gliomas) opens up avenues for 2 therapies #btsm
- T3 in lung cancer oncogenic alterations in EGFR ALK ROS1 RET et cetera determine treatment choicces
- T3 In many types of cancer, seeing whether the tumor makes the PD-L1 protein can determine whether treatment with a type of #immunotherapy drug called an immune checkpoint inhibitor is appropriate.
- T3: and... finding #H3K27m mutations opens the door to try drugs like #ONC201 (as seen at #ASCO19
- T3: SO MANY OPTIONS can be identified through biomarkers. Hormone therapy, immunotherapy, targeted kinase inhibitors, antibodies like herceptin... They can also point to clinical trials
- Analysis of mutations in EGFR+ NSCLC (and other oncogene-driven cancers) can also help determine how to treat resistance to targeted therapies.
- In myeloma the expression of BCMA is used as a biomarker for CAR-T cell therapy
- T3: If the molecular biomarker testing shows that the patient's cancer contains the therapeutic target, then that patient might benefit from treatment with the corresponding drug. This is personalized medicine!
- T3 These drugs, like all drugs, have side effects, so beyond the needless cost, it is important to not treat patients with these molecular therapies if the biomarker testing shows that the drug would not benefit the patient
T4: What biomarker tests should be run for which types of cancers? What is a liquid biopsy and when is useful?
- T4 There are guidelines for what biomarker testing must be performed on different cancer types. https://t.co/0NmT5EaL4E
- T4: "Liquid biopsy" refers to molecular biomarker testing performed not on a patient's cancer tissue, but on cancer cells or cancer cell DNA or RNA that is floating in the blood stream.
- T4 For lung cancers, the minimum testing that must be performed is to look at the EGFR gene for mutations and ALK1 and ROS genes for rearrangements. Many pathologists examine other more recently recognized mutations.
- T4 A #liquidbiopsy is a test done on a sample of blood to look for cancer cells from a tumor that are circulating in the blood or for pieces of DNA from tumor cells that are in the blood.
- T4 For colon cancers, RAS gene testing to guide anti-EGFR therapy. BRAF mutational testing should also be performed for prognostic information.
- T4 For Breast cancers, the pathologist performs testing for estrogen receptor, progesterone receptor, and HER2 by immunohistochemistry
- T4 A liquid biopsy may also be used to help plan treatment or to find out how well treatment is working or if cancer has come back. Taking multiple samples of blood over time may also reveal the molecular changes taking place in a tumor.
- T4 From NCI’s Cancer Currents blog last year: Liquid biopsy may predict the risk of breast cancer returning years later: https://t.co/zuL4GnA0CV
- T4: Liquid biopsy is used in cases where a biopsy of a patient's cancer cannot be performed because the patient is too ill to tolerate the diagnostic procedure, or where the cancer site is difficult to access with a biopsy e.g., a lesion deep inside the body
- T4 And here’s an overview from 2017 of the evolving science around liquid biopsies and the important research questions: https://t.co/zqj48vhMbG
- T4: I love the quote about liquid biopsies-- It's like looking for a needle in a haystack. If you find a needle, it's a needle. But if you don't find the needle, it doesn't mean one's not there. A negative result always needs to be followed up by testing tissue
- Most liquid biopsy tests are not yet covered by insurance. However, most test manufacturers can provide some financial assistance.
T5: Can and should patients pursue biomarker testing for treatment options if their doctor does not offer it?
- Yes! Push for best care possible. It's my oncologist's job but it's my life
- T5 NCI does not have guidelines for the use of tumor markers. However, some national and international organizations have guidelines for the use of tumor markers for some types of cancer: https://t.co/o85pqHZKoy
- T5: Molecular testing and molecular therapy has become the standard of care for many cancers. Most doctors are performing the recommended molecular testing on particular types of cancer.
- T5 absolutely! doctor should always point out all possible options even if not available at his/her own institution
- As @JFreemanDaily bought up, the NCCN guidelines are a great resource and an excellent place for patients to find out what the current recommendations are and ask questions of their doc's if there is a variance https://t.co/X5OVXPY9g6
- T5 The basic question to ask your doctor is "Given my diagnosis, is molecular biomarker testing is right for me?" You can read about guidelines which are specifically designed for patients at
- https://t.co/yyMAKwn2RK
- T5: Second opinions are almost always a good idea - especially in cancer. Seek doc's with high case volume of your specific type of cancer. You are you own best advocate and the science is changing fast
- T5: It's always a good idea to ask your doctor about molecular testing; but given the confusion in this rapidly changing area, it may be difficult to know what to ask your doctor. Feel free to call your pathologist and discuss!
- Get your pathology report and usually there's a phone number. If not, your hospital or clinic should be able to provide
We are so glad that #gyncsm could be an part of this important discussion.
Dee
#gyncsm co-founder
Resources
Kyle Strimbu and Jorge A. Tavel, M.D. What are Biomarkers? (2011) https://t.co/CV1ROepZnS
NIEHS: Biomarkers https://t.co/cNuwLouCPJ
FDA: BIOMARKER TERMINOLOGY: SPEAKING THE SAME LANGUAGE https://t.co/Ua6gPOZevl
FDA: What Are Biomarkers and Why Are They Important? Transcript https://t.co/Ndpiy1XWlp
lay friendly overview https://t.co/GnpK7bWJkm #cancersm @CancerDotNet
This is a great slide. #MMSM #Biomarkers https://t.co/XvmjWfL296
Salivary Biomarkers: Toward Future Clinical and Diagnostic Utilities https://t.co/Q4bzv0UQoc
Salivary biomarkers and proteomics: future diagnostic and clinical utilities https://t.co/Epp0cUOsdq
VOC breath biomarkers in lung cancer (2016) https://t.co/TmvUTPyxkp Blinded Validation of Breath Biomarkers of Lung Cancer, a Potential Ancillary to Chest CT Screening (2015) https://t.co/ccpsi93wS2
MIT Tech Review: Liquid Biopsy Fast DNA-sequencing machines are leading to simple blood tests for cancer. (2015) https://t.co/hw4kQVftKq
Biopsia líquida https://t.co/jsmZvQYM8H
