2021 CSCO companion diagnosis special session breaks through technical barriers and promotes the clinical implementation of precision diagnosis and treatment

The theme of the 2021 CSCO Annual Conference is "Focus on Innovative Research, Leading the Original Future", and hot topics such as MRD, ctDNA, and NGS applications for tumor precision diagnosis and treatment once again hit the venue
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September 28, with "precision | see 'micro' know the, proud 'melt' 'companion diagnostic tumor-themed concert will be held successfully
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Professor Wu Yilong from Guangdong Provincial People's Hospital, Professor Lu Shun from the Chest Hospital of Shanghai Jiaotong University, Professor Wang Jie from Cancer Hospital of Chinese Academy of Medical Sciences, Professor Yang Fan from Peking University People's Hospital, Professor Jiang Guozhong from the First Affiliated Hospital of Zhengzhou University, Professor Wang Yongsheng from West China Hospital of Sichuan University, etc.
Experts conducted in-depth discussions on the new developments in the field of MRD detection, the prospects and technologies of DNA+RNA double fusion detection and liquid biopsy level PD-L1 expression detection
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Deeply planted roots Advancing the clinical application of MRD with extreme technology.
Minimal residual disease (MRD) is actually not an unfamiliar concept.
It has been used in hematological malignancies for many years
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In recent years, with the advancement of gene sequencing technology, the improvement of clinical research data, and the formation of consensus on detection and clinical application, MRD has gradually gained recognition and attention in the clinical application of solid tumors
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Professor Wu Yilong pointed out that China’s first "Consensus on the Detection and Clinical Application of Lung Cancer MRD" was released in 2021.
For locally advanced non-small cell lung cancer (NSCLC) patients with complete remission after radical chemotherapy and radiotherapy, it is clearly recommended to test MRD to help determine the prognosis and make further developments.
Treatment strategies
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MRD is the direct cause of tumor recurrence.
A positive MRD test indicates the continued existence of the tumor and the possibility of clinical progress, which can help doctors to more accurately measure the effectiveness of treatment and predict the risk of patient recurrence
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The actual clinical needs drive the pace of exploration and innovation in detection technology.
Circulating tumor DNA (ctDNA) is one of the most effective means of detecting/monitoring MRD, and high hopes are placed
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In terms of the exploration of MRD detection, as early as 2019, Herui Gene published the results of cooperation with the team of Academician Wang Jun of Thoracic Surgery Department of Peking University People's Hospital in the official journal of the American Association for Cancer Research (AACR) "Clinical Cancer Research"-DYNAMIC Research
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The DYNAMIC study found that 3 days after surgery can be used as the best time point for postoperative MRD monitoring
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This study is the first international prospective study to accurately assess the dynamic changes of ctDNA during the perioperative period.
It is also the first study in Asia to use ctDNA to monitor the residual small lesions after lung cancer surgery
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He was once listed as a bright spot study by an international authoritative review journal and specially wrote an article review, believing that the study provides a new perspective on postoperative monitoring of lung cancer and may help clinical decision-making
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At this meeting, Professor Yang Fan shared the current technical challenges and future directions of MRD detection with the topic of "Consolidating the Foundation and Achieving a New Chapter in Lung Cancer MRD"
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He said that because the content of ctDNA in the blood itself is low, it has always been a technical problem to capture the signal from the tumor
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Therefore, it is necessary to realize the detection of ultra-low abundance ctDNA technically to truly break through the bottleneck
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Based on the Dynamic research, Herui Gene continued to cultivate and explore the optimization plan for MRD detection, and launched the solid tumor MRD detection program during CSCO-Hezhuan, which is designed and developed for perioperative solid tumor MRD monitoring and can be used for dynamic evaluation.
The status of minimal residual lesions during the perioperative period indicates the risk of postoperative recurrence of patients, and at the same time can provide reference information for medication treatment and predict prognosis, and help patients to manage the entire course of the disease
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The detection program first performs solid tumor large panel gene detection on the tumor tissue of the patient to obtain a gene mutation map of the patient, and at the same time provides targeted, chemotherapy, and immune drug prompts for the patient's neoadjuvant/adjuvant therapy
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Then, based on the exclusive MRD detection panel, the postoperative plasma samples are monitored dynamically at multiple time points and with ultra-high sensitivity to help patients find disease recurrence early and improve patients' survival benefits
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The advantages of Hezhuan detection solution MRD detection achieve more breakthroughs, and more innovative detection technologies and clinical research are needed
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Professor Yang Fan mentioned: The future direction of MRD is joint detection.
In this regard, we are working with Herui Gene to explore the application of low-depth WGS technology in MRD, in order to further improve the sensitivity and specificity of MRD detection
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From the publication of Dynamic research to the clinical application of Hezhuan, from the exploration of the optimal time point for postoperative MRD monitoring to the exploration of ctDNA combined with low-depth WGS MRD detection scheme, under the guidance of the original spirit, research, technology and clinical workers continue to Break through the technical bottleneck and help promote the full clinical implementation of MRD
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Continuous breakthroughs in existing technologies have paved the way for the true solution of MRD application problems in the future
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Looking forward to the future, as the diversified MRD detection technology continues to advance to the extreme, it will surely further rewrite the treatment pattern of solid tumor patients
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Breaking through barriers.
Blood RNA fusion detection helps to truly realize DNA+RNA fusion detection.
At present, a number of international and domestic guidelines and expert consensus recommend the combination of DNA detection and RNA detection, which can comprehensively cover gene fusion/rearrangement, and improve it to a greater extent Clinical benefit rate
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And many studies have proved that fusion detection can achieve the simultaneous determination of core therapeutic targets and rare and effective fusion mutations, make up for the possible missed detection of conventional detection methods, unclear fusion genes and other deficiencies, and effectively improve the detection of fusion genes.
Outcome rate, better help doctors in clinical diagnosis and treatment
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Professor Jiang Guozhong said that the "double inspection" fusion, that is, the simultaneous detection of DNA and RNA, can more effectively rule out the possibility of the existence of the two
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In clinical practice, no matter from the comprehensive considerations of cost, time and samples, joint testing can benefit patients more
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The current technology for detecting fusion can be performed at the DNA level, RNA level, and protein level (such as FISH, RT-PCR, immunoomics, next-generation sequencing), but in specific clinical applications Each has its own advantages and shortcomings
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Professor Jiang Guozhong introduced that Herui Gene is an excellent molecular diagnostic platform introduced by the First Affiliated Hospital of Zhengzhou University.
Since 2017, it has been committed to the development of better fusion detection technology and products, using DNA+RNA parallel detection, and in the probe The design and capture strategy are continuously optimized, combined with the unique SVscan® patented algorithm, which can more efficiently perform in-depth mining and fusion analysis of RNA data, so that the overall RNA detection success rate is increased to 91.
52%, that is, a guarantee of 91.
52% The patient achieves double inspection of DNA and RNA genes
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In clinical practice, he did see that DNA+RNA parallel detection is more accurate for fusion detection and brings more opportunities for patients to benefit.
At the meeting, he shared a number of cases passed by Herui Gene and Quan’an Panel.
The use of DNA+RNA technology to achieve accurate fusion detection and clinical cases of patient benefit
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Herui Gene DNA+RNA Blood Test SpCap Technology In the more difficult in-depth exploration of the use of liquid biopsy for fusion detection, Herui Gene continues to break through the technical bottleneck and independently developed SpCap cfRNA detection technology, which is in the extraction and construction of The library detection has superior performance, which can realize the stable, efficient and rapid extraction of cfRNA and the detection of library construction, breaking through the technical bottleneck, and filling the gap in the double detection of DNA+RNA fusion in blood samples
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Professor Lu Shun also pointed out that there are not many large panel products that can achieve dual detection in China.
Herui Gene has realized the dual fusion detection of DNA and RNA, which can significantly improve the detection accuracy of fusion genes and allow more The patient finds the precise target to get precise treatment
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As a national enterprise, Herui Gene continues to base itself on clinical needs, technological innovation, and solve various problems encountered in clinical practice, reflecting the mission and responsibility of the national enterprise
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Face the pain point and challenge the detection of PD-L1 expression at liquid biopsy level "PD-L1 expression is one of the most mature predictive markers in immunotherapy companion diagnosis, and its clinical value has long been fully recognized
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But the real problem is immunohistochemical PD-L1 expression can not detect the presence of the organization and of the organization express temporal and spatial heterogeneity and other issues
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liquid biopsy is non-invasive, easy access, the ability to dynamically monitor and many other advantages, such as liquid biopsy can achieve levels of PD-L1 expression was detected, will clinical significance
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"Professor Wang Jie pointed out
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Although the PD-L1 test is widely used in clinical practice, the diverse standards of the PD-L1 immunohistochemical test platform and the diversity of characterization methods will affect the predictive value of the PD-L1 test
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The actual demand in the clinic is the driving force for the continuous exploration and innovation of technology.
How to break through the technical problems and realize the detection of PD-L1 expression at the liquid biopsy level is a problem that Herui Gene has been thinking about
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Professor Wang Yongsheng introduced that many studies have shown that at the genetic level, the structural variation of the 3'end UTR of PD-L1 is closely related to the expression of PD-L1, with very high consistency, and is closely related to immune escape and the efficacy of immunotherapy.
It is relevant and has good detection value
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At the same time, the detection of PD-L1 gene 3'UTR structural variation, especially the detection of ctDNA level, has great technical challenges, and has high requirements on the design of detection product probes and biometric algorithms
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How to overcome the challenge of gene structure mutation detection has become a difficult and painful point of current clinical technology exploration
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Optimizing probe design, performing DNA+RNA dual detection, and developing a biometric algorithm for 3'UTR structural variation broke through the existing technical difficulties
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In this regard, Herui Gene, a representative domestic tumor whole-course management genetic testing company, has optimized the probe coverage and capture strategy, using its advantages in the field of DNA+RNA dual detection for many years, and used the self-developed SVscan® patent algorithm.
, "Meeting" the challenge of gene structure variation detection
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"In clinical practice, the Hequan-Solid Tumor Whole Target Gene Detection (654 gene) product of Herui Gene has found 7 cases of PD-L1 gene 3'UTR structural variation, including intrachromosomal translocation, chromosome deletion, chromosome There are three types of translocation between them, and the consistency of blood ctDNA and tumor tissue DNA detection is 100%
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"Professor Wang Yongsheng said
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The advantages of Herui gene PD-L1 multi-dimensional detection technology.
In addition, the copy number change of PD-L1 gene also has good predictive value
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It is reported that Herui Gene Development and Quan'an-Solid Tumor Whole Target Gene Detection (654 gene) products adopt a multi-dimensional PD-L1 detection strategy.
In addition to the immunohistochemical PD-L1 protein expression level detection, it will also be carried out at the same time.
PD-L1 gene copy number variation detection and PD-L1 gene 3 end UTR region detection to help achieve better immunotherapy guidance
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Conclusion At this stage, detection first, treatment second, has become a standardized process for accurate tumor diagnosis and treatment.
The detection results guide clinical decision-making and drive the standardization of diagnosis and treatment, which promotes the accurate management of tumors throughout the course of the disease to gradually become a reality
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In the 2021 CSCO annual meeting, Herui Gene has become a unique and dazzling new star in the field of precision diagnosis and treatment by virtue of a number of innovative research, independent research and development leading technology, and breakthrough products.
It has been highly recognized by clinical experts at the same time , Which has further consolidated its position as a leader in genetic testing for the whole course of cancer management in China
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Typesetting: Qin Miao Editor: Wang Lina Review: Xu Fengyan For more content, please click: Academician Dai Kerong: Life is to find a way, recognize the way, hurry, lead the way, give way to the Chinese Physician's Day·Healthy China subway train poster story ㊹ | Luo Xiaoping: Take good care of children Health is to grasp the future of China.
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