[pauley.18]

Holly, I also think your questions and insight were well put. My understanding with Ambry was that it was a tool to see if someone carried different genetic traits that could increase their risk of certain cancers. I wonder if they receive and positive result if it would then benefit utilizing liquid biopsies to show they also carry the early tumor markers.

[pauley.18]

1. What was the knowledge gained from the article?
What I thought were considered liquid biopsies was expanded further. I thought that only samples being analyzed for blood cancers or the utilization of fine needle aspirations were considered liquid biopsies. The articles demonstrate the possibility of diagnosing cancer at much earlier stages.

2. Will the research/information in this article change or influence your practice? If so how?
My practice will not be changed or influenced by these articles, but my knowledge was increased on the utilization of this type of testing.

3. What other questions does the article raise about current practice?
The articles raise the question of utilizing the liquid biopsy as a tool to diagnose some cancers early and have the ability to then formulate a care plan, maybe more effectively. But, to me a better concern raised is by Lone et al is how can this be implemented effectively in everyday practice? With being a part of the best cancer center in the world, I would think our university would see the value and maybe develop a program to begin the implementation for our patient if truly valuable.

4. Do you agree/disagree with the conclusions of the author, why?
I agree with the conclusions of the authors of both articles. Having the ability to diagnose cancer sooner could
foster an earlier diagnosis, possible lessen the stress on the patient and their family knowing the diagnosis was very early, and lessen the cost of treatment overall.

[lu-hsu.24]

Hello, I am Stephanie from CTU.

What was the knowledge gained from the article?
It is very interesting reading about liquid biopsy and all the benefits of how it can be used for obtaining diagnosis information, staging, tumor condition in ‘real-time’, and prognosis. What a wonderful option to be able to get information from a patient in a less invasive way in comparison to the current tissue biopsy practice. I hope liquid biopsy will soon become an option as a standard way for diagnosing and guiding treatment.

What other questions does the article raise about current practice?
How is it that it has been known since the 1860s and we are still not using it as a standard way of getting tumor information? What will need to happen to have liquid biopsy become a more common way of diagnosing?

Do you agree/disagree with the conclusions of the author, and why?
Unfortunately, I agree that there are always some limitations to any advancements due to costs. I also agree that liquid biopsy does have benefits in that it is less invasive but also has its limitations of specificity and sensitivity due to the lack of current technology.

[lu-hsu.24]

Jeff
Thank you for sharing these journals with us. It was interesting to read about a less invasive way to obtain information from our patients in comparison to the current practice of tissue biopsy. I also find it interesting on what drives new technology and standards of care for our patients.

Greg
I agree with you. I too, was unfamiliar with liquid biopsy. This is the reason I enjoy journal club. We get the opportunity to learn about different options to help care for our patients.

Katie
You brought up a good question about how we are currently checking specific labs and if these are considered liquid biopsies. The response Jeff submitted gave a better understanding of the labs and how we are currently utilizing the information.

[strohschein.2]

1. What was the knowledge gained from the article?
I have honestly never heard of liquid biopsies before reading these journal articles. When I thought of “liquid biopsies” I also did not picture in my mind the procedure to be performed as it was described in the articles or the cancer types it could detect. I found these articles to be incredibly fascinating! As I began reading the articles my initial thoughts were, “Wait, why aren’t we doing these in clinic?” But after I finished reading, I learned that there is still much more that needs to be researched.
2. Will the research/information in this article change or influence your practice? If so how?
Liquid biopsies are not currently being performed for my department. With that being said, I would like to present these articles to the providers on my unit and gather their opinions on this biopsy. Currently, we use the standard practice of gathering biopsy cores from the bladder, kidney, and prostate. When I educate my patients on the biopsy procedure, some patients have turned away when they hear, “You will have blood in your urine, semen and stool for up to 30 days” and “you may also experience difficulty urinating and need a catheter placed after the procedure.” Liquid biopsies could be great minimally invasive option for patients to choose.
3. What other questions does the article raise about current practice?
Liquid Biopsy price? Currently, in the urology clinic we have a test called “4k score” which is a in depth predictor on the likelihood of developing a high-grade prostate cancer. The cost of the 4k score is $700 without insurance for one tube(5ml) of blood. With the liquid biopsies, I’m assuming it is affordable to only a select few of patients.
4. Do you agree/disagree with the conclusions of the author, why?
I agree with the authors on both articles that current practice is limited and advancement in technology is necessary for early detection and multi organ cancer involvement. Liquid biopsies could hold promise for patients in the future, but more research is needed.

[strohschein.2]

Jeff- Thank you for sharing these articles with us for this month’s journal club. I have never heard of liquid biopsies before, and I am interested in showing these articles to the providers on my unit and gathering their thoughts. I too am intrigued on what type of research, equipment and costs it will take to increase the sensitivity and accuracy of liquid biopsies.

Stephanie-I agree with what you said about liquid biopsies not being readily accessible or a priority for patients, when tumor cells were being reported in the peripheral blood of patients since the 1860s. With the information I gathered from the two articles, I believe we will see a time when liquid biopsies are the standard practice.

[blackwell.72]

What information did I learn?

I learned a lot! Surprisingly, there were multiple different ways to test. I never gave a liquid biopsy much thought before reading these articles. It makes sense that we should be able to detect cancer with a liquid biopsy if we can detect tumors and their status with blood tests.
2. How will the information gained change my practice?

This will not currently change my practice. Gyn/Onc pelvic exams reveal a cancer or precancer before a scan but I am guessing that the liquid biopsies would be an earlier detection than an exam? As always, I will be asking more questions about this during my clinics.

3. What questions does the article raise about current practice?
Since we already use blood for genetic testing, could we get more information from 1 blood draw than we already are? This may be better utilized for family members that do not have a diagnosis to test their genetics and also test for cancer detection at the same time. I actually have had patients that within a few months a sibling, parent/child were diagnosed with the same cancer. If this is a possibility then it could possibly encourage more family members to do genetics testing. I have to disclose that I am not big on “genetics” because they are the bullet and lifestyle pulls the trigger BUT if one already has a diagnosis then genetics are obviously very beneficial to know.

4. Do you agree or disagree with the conclusions of the author, why?

I do agree that is a great option to test less invasive and get earlier detection. The fact it takes 300ml for a test is a little alarming and definitely room for improvement. Honestly, with all the technology it is pretty disappointing that this has not already been perfected. Considering how much time and money is put into cancer research I personally feel we should be much farther ahead with diagnostics and treatments.

Jeff- thank you for leading this. I agree, we should continue to research and begin to utilize the liquid biopsies in our patient care more often. We have so many good topics in this club, it would be cool to have an “update board” to post anything new we are doing within our clinics on the topics we have discussed. We vary so much in our patient care and yet they want to make us be exactly alike!

Greg- I agree we need are great early and specific detection, lung cancer is not the only one – Pancreatic also but personally, I feel the signs/symptoms are there but they are ignored like acid reflux or blamed on gallbladder.
So many options we are not exploring and/or using in cancer care.

[Author]

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