A liquid biopsy can detect which cancer patients may be at higher risk of developing other cancers

Barcelona, Spain: Liquid biopsies are increasingly used in patients' daily care to identify and monitor cancer progression, researchers have found, and it can also detect bleeding cell disorders that put patients at higher
risk for blood cancers.
The results were presented
Friday at the 34th EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics, held in Barcelona, Spain.

Tumors transfer DNA into the bloodstream, which forms what is known as cell-free DNA (cfDNA).

cfDNA can be identified in a blood sample taken from a patient or a "liquid biopsy," which allows doctors to better describe the cancer, choose the best treatment, or monitor the progression of the disease and its response to treatment without having to perform an invasive biopsy
of the tumor itself.

A condition called clonal hematopoiesis (CH) is a relatively common incidental finding in liquid biopsies, and researchers at the Gustave Roussy Institute (Villejuif, France) wondered if these biopsies could also be systematically used to identify patients who have or may be at higher risk of developing blood cancers, such as myelodysplastic syndrome (blood cell disorders originating in the bone marrow) or acute myeloid leukemia
.

CH
occurs when a type of cell called hematopoietic stem cells begins to produce genetically mutated cells with a different inheritance pattern than normal blood cells.
Hematopoietic stem cells are produced in the bone marrow and can develop into different types of blood cells
.
These cells also release DNA
into the bloodstream.
Previous studies have shown that the absolute risk of CH developing into a blood cancer is about 1% per year, and the relative risk increases 10-fold
.

Between March and October 2021, researchers performed liquid biopsies
on 1,416 patients with various solid tumors who participated in the Gustav Roussy Cancer Profile Study (STING).

Dr.
Marco Tagliamento, an oncologist and researcher at the Gustave Roussy Institute in France, said at the symposium: "We found that 113 patients (8%) had at least one clonal hematopoietic mutation, which may put them at higher
risk of developing blood cancer in their lifetime.
" Of these patients, 45 were referred to our hematology department by their oncologist and 5 were subsequently diagnosed with blood cancer: 1 had myelomonocytic leukemia, 2 had myelodysplastic syndrome, and 2 had essential thrombocytoemia
.
”

The researchers believe that when a liquid biopsy reveals that a patient has high-risk CH features, in some cases further hematological evaluation should be triggered to reveal the actual risk of developing a blood cancer or to discover that
the patient already has a blood cancer.

"Early detection can prevent complications during anti-cancer treatment, such as changes in blood counts, and consequent interruptions or delays
in treatment.
It can also point doctors to possible avenues
for the diagnosis and treatment of blood disorders.
”

In its work to determine which patients should be referred for further research, the Gustave Roussy Molecular Oncology Committee carefully considered each case to identify genetic mutations
associated with CH.

"Case evaluations are critical," says
Dr.
Tagliamento.
"Different aspects
must be considered when evaluating the potential impact and management of high-risk clonal hematopoiesis in patients who already have cancer.
For example, these are related to
the patient, their medical history, and the underlying cancer.
All of this should be part of a balanced assessment of
each case.

"We will continue to apply this approach
within the Gustave Roussy Molecular Oncology Committee.
" We want to implement and improve the efficiency of the algorithm to select solid cancer patients who can benefit from hematological assessment
.
These results were part of
a team project led by Dr.
Mihaela Aldea and Dr.
Jean Baptiste Micol.
”

Professor Ruth Plummer from Newcastle University in the UK chaired the 34th EORTC-NCI-AACR symposium and was not involved in the study
.
"This is a well-conducted study that reveals another aspect of
the information obtained from the liquid biopsy," she said.
Dr.
Tagliamento is right
to emphasize the importance of assessing each patient's individual situation.
Cancer patients have a lot to worry about, so their doctor needs to consider the patient's clinical situation and their treatment plan
.
Patient anxiety means that highlighting the potential increased risk of developing additional blood cancers later in life is not always appropriate
.

"Only a few specific clonal hematopoietic mutations may predict a higher risk
of developing blood cancers at some point in the future.
" This study suggests that patients with these mutations should undergo further evaluation, and even then, the best treatment for these patients will depend on a range of other factors
.
”