How Dracula Tests For Cancer
First off… fuck cancer.
There are so many things that suck about cancer.
It’s one of those words that for so many people, conjures up so many unwelcomed emotions, to the point that they would rather not talk about it at all.
Or get screened for it.
And can you blame them?
Most of the screening procedures we have in place today involve some level of radiation, i.e. mammography, or CT scans. And colonoscopies — while they don’t involve radiation, or a visit to the operating room, few people would refer to them as non-invasive.
To make matters worse, when people actually do muster up the courage to visit their physician, current standard-of-care screening tests, like mammography and colonoscopy, only detect less than 30% of all incident cancers.
With breast cancer for example, the detection limit of breast cancer tumors using ultrasound and mammography is 6 mm or larger. Small lesions or micro-metastases are difficult to spot.
We all know someone who has been affected by cancer. For me, it was my sister-in-law. She was one of the lucky ones. Not everyone can say that.
According to cancer.org, in 2020, there were an estimated 606,520 cancer deaths in the United States.
Obviously we’re not talking apples to apples here, but for comparison, in the last 12 months, Covid-19 has killed a little more than 500k people in the United States.
With Covid, we now have vaccines in play. There’s no vaccine for cancer. It’s not that simple.
Maybe we don’t have a vaccine to look forward to, but with all the advancements in technology, innovations in the medical field, and smart people working on smart problems, we must be on to something, right?
Right!
When cancer is caught in its earliest stages, the chances of beating it skyrocket 🚀.
Survival statistics can vary based on a number of factors, like the type of cancer, stage of cancer, age of the person, and time period in history, for example.
But, you’ll be hard-pressed to find a doctor, or a study, that doesn’t advocate for early detection.
FYI, the images above show the 5-year relative survival rate. Those numbers represent the percentage of people who will be alive 5 years after diagnosis.
The earlier the stage, the higher the percentage of survival. Period.
Why do people have a better chance of survival with early detection?
One of the biggest benefits of detecting cancer in its earliest stages, is to help stop the spread of cancer to other places in your body, aka metastasis.
Okay. We want to find it earlier. But how?
Let me introduce you to liquid biopsies.
They’re an exciting new technology with a lot of potential to make a real difference in the cancer community.
You’ve likely heard of a biopsy before.
Typically, this process involves you going under the knife, in an operating room, under anesthetics. And depending on where you’re reading this, you might be paying for some or all of that. Fun for literally no one.
The whole point of this procedure is to cut a small piece of the potentially cancerous tumour out of your body, so it can be studied to help inform treatment and next steps.
But these procedures can be extremely invasive, if even possible. There are certain cancers in the lung, brain, bone, etc. that can make tissue biopsies dangerous.
If people have fear around screening procedures, you can only imagine the reluctance of the actual biopsy, which is why for many people — when it comes to cancer detection, ignorance is bliss.
Which sucks. But it doesn’t have to be this way.
Humour me for a minute. What if we could glean all of that same information from the invasive biopsy, through a simple blood sample, similar to taking a blood test at your family doctors office?
(Other bodily fluids can work as well, however, for the purposes of this article, we’re focusing on blood.)
That’s where we’re headed with liquid biopsy.
Here’s a wonderful 2 minute overview, if you’re a visual learner like me.
Sounds great like a great step forward. What are they looking for in the blood?
Thanks to some important discoveries, we now know that cancers release small pieces of themselves back into the bloodstream. So, we can collect blood, look for specific things floating around in the blood, and then make some more informed decisions about treatment options, i.e. how well certain therapies are working, how the cancer is reacting to those therapies, and potentially, even detect cancer in ways traditional screening methods currently can’t.
Things floating around in the blood?
If you want to impress your friends in accounting, call them biomarkers.
If you want to impress your friends in the sciences…
These liquid biopsy analytes include:
- circulating tumour cells (CTCs)
- circulating nucleic acids (including circulating tumour DNA (ctDNA)
- the tumour- derived fraction of cell- free DNA (cfDNA) in the plasma
- as well as cell- free RNAs (mRNAs, long non- coding RNAs and microRNAs)
- extracellular vesicles, tumour- educated platelets, proteins and metabolites that can be found in a range of bodily fluids.
The two most commonly discussed biomarkers, and the ones that we’ll be focusing on in this overview are circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA).
How are we detecting those biomarkers within the blood?
There are a few different detection methodologies that researchers are using, but the one that I’m personally most excited about, falls within the category of Next-Gen Sequencing (NGS) which is the most sensitive of the technologies.
Currently, multi-mutation Next-Gen Sequencing (NGS), like CAPP-Seq, is the most sensitive of the technologies.
CAPP-Seq is a very sensitive and specific method of detecting small amounts of ctDNA. It was developed by the Diehn Lab in collaboration with the laboratory of Dr. Ash Alizadeh. CAPP-Seq was able to lower sequencing costs by “only targeting specific areas of the genome that are recurrently mutated for a given cancer.”
You’ve likely heard of the Human Genome Project where we mapped out all human DNA. Cancer has something like that too in the form of the Cancer Genome Atlas. Think of it like a big database of the different types of genetic makeup for cancer DNA.
So now we know what to look for, and have things like CAPP-Seq that makes it easier to find it.
Easier, but not easy.
The earlier the stage of cancer, the less cancer particles are floating around.
It’s that whole needle in a haystack dilemma.
So, much like traditional screening methods, even with liquid biopsy — the later the stage that the cancer is, the more cancer particles are floating around, and the more likely it will be detected.
Right… but your whole thing was about wanting to find cancer in it’s earliest stages.
We know that the technology is limited right now because these biomarkers are so rare in the bloodstream, not to mention tumours have many different types of cells and a variety of genetic mutations.
So not only is it a needle in a haystack, that haystack is full of a lot of other distracting material as well.
Fortunately though, recent advancements in the field, led by some innovative companies, are tackling these problems, specifically.
Problems that if solved, would enable medical professionals to use liquid biopsy tests to be so specific, and sensitive, even with only small amounts of particles floating around.
Meaning?
Meaning that we’d have a much greater chance at finding cancer in its earliest stages, using liquid biopsy… which in my humble opinion is a moonshot worth shooting for!
Investors think so as well. This is due in part to the enormity of the problem that early stage detection through liquid biopsy could solve, but also at the size of the market it will create.
The team at Motley Fool believe this could be upwards of a $150 Billion dollar industry, which they talk about in the 4 minute video.
So, who is in this race?
There are many more companies than I had imagined. Here are just a few…
- Guardant Health (NASDAQ:GH) is one of the bigger players, having already launched two liquid biopsy-based tests into the market.
- Another company to watch is Illumina (NASDAQ:ILMN) who are hedging their bets with a spin-off company, GRAIL, which is focused on early detection tests via liquid biopsy. But if they don’t win that race, Illumina has also developed gene-sequencing technology used by GRAIL and other companies to analyze ctDNA in liquid biopsies.
- A Canadian contender out of British Columbia, Liquid Biopsy Labs, claims that with their tests, you can see any new tumor growth more than 8 months before tumors would be visible through even the most advanced imaging diagnostics, such as PET/CT.
The race is on!
- Just last year, Karius raised $165 million USD for its liquid biopsy technology test that they claim “can measure the cell-free DNA of more than 1,000 clinically relevant samples from things like bacteria, DNA viruses, fungi and parasites.”
- Like Karius, the company Thrive recently raised a healthy series A round, at $110 million USD, and is making tangible progress in using liquid biopsy to detect cancer at early stages.
And Thrive is putting that money to work.
They recently released data from their DETECT-A study that involved 10,000 women with no prior history of cancer.
Here are a few key highlights from the study:
- 25% of the women who were diagnosed with cancer were identified by current standard-of-care tests. By incorporating Thrive’s blood test, the percentage of “screen-detected” cancers increased from 25% to 52%.
- Thrive’s blood test identified cancers across 10 different organs, seven of which currently have no standard-of-care screening.
- Thrive’s blood test can identify cancers prior to clinically evident metastasis. 65% of the cancers identified were localized or regional.
- Thrive’s blood test is additive and complementary to standard-of-care and was incorporated into routine medical care without discouraging patients from engaging in other forms of screening.
- Thrive’s blood test, in combination with imaging, minimized false positive results with 99.6% specificity.
Studies like this show just how promising this emerging field can be.
Can you imagine the trickle-down implications that would come into play for the healthcare system, the economy, and for our families, if 600k Americans were able to detect their cancer at a much earlier stage?
I’m cautiously optimistic. It’s important to note that there is still a long way to go before we can confidently tell cancer to fuck off, for good. Or even that we’ll be consistently catching it in its earliest stages.
The findings I mentioned in this post are mostly research based, which means this technology still has many hurdles to jump before making it into the clinicians office for everyday use.
One such hurdle is the role that we will need machine learning, and artificial intelligence to play in improving the datasets, and underlying algorithms that will be essential for this technology to be adopted at scale.
We’ll tackle the role that ML/AI can play in potential future applications of liquid biopsy in part 2 of this series.
Here’s a teaser to wet your appetite…
Like you, I’m learning. It’s a journey, and I’m just getting started.
Come along for the ride. Leave me a comment, and let me know what you thought!
And while you’re here, donate your money, blood, or both, to a cancer research organization near you.
Damian
