August 19, 2018

A less-invasive approach takes a personalized medicine approach to cancer care.

Blood biopsy is a new approach to capturing genetic information about patients with cancer, which can lead to personalized therapies, according to one expert.

Less invasive than surgery, this means of capturing genetic information from patients allows providers to assess patients’ possible recurrence of cancer over time-that’s because it’s relatively easy to capture patients’ blood multiple times.

Providers are more accustomed to using surgical biopsies to take a personalized medicine approach to cancer care, says Wei Zhang, PhD, director of cancer genomics and precision oncology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. Surgical biopsy helps providers tailor the appropriate treatments for each patient’s cancer.

Specifically, surgical biopsy involves the removal of a sample of the cancer, according to the National Cancer Institute. The sample is then analyzed at a lab, where a DNA sequencer can detect genetic changes that can cause the cancer to grow. With blood biopsy, once the patient has their blood drawn, this information is similarly analyzed in a lab. Healthcare providers can use this genetic information to tailor specific treatments for patients with cancer based on their DNA.

Typically, biopsies are taken when patients are in more advanced stages of their cancer. Zhang advocates for doing blood biopsies earlier in patients’ cancer journeys. For example, with women with endometrial cancer between the ages of 30 and 40 years who have the beta-catenin gene, which makes them more likely to experience a recurrence of their cancer.

Zhang, who is also a National Foundation for Cancer Research fellow, says that sequencing of circulating DNA in blood for genetic mutations has been used since the early 1990s to check for specific mutations in KRAS, EGFR, and TP53 genes, all of which can be used to tailor therapies for patients with cancer. Blood biopsies, which he describes as “a relatively high throughput, multipanel sequencing,” has been around for the past five years.

While surgical biopsies are covered by CMS and private payers, blood biopsies are not covered by CMS nor are they approved by the FDA, he says. Still, he’s encouraged by an announcement that Columbia, South Carolina-based Palmetto GBA, a Medicare administrative contractor, will cover the Guardant360 assay, a blood biopsy.

According to the announcement, the Guardant360 assay has been ordered more than 70,000 times to help inform appropriate treatment paths for advanced-state cancer patients with solid tumors. The company’s blood biopsy is covered by private payers such as Cigna and several Blue Cross Blue Shield plans. Zhang anticipates FDA approval for blood biopsies within a year.

He adds that Wake Forest has used blood biopsies for genetic sequencing of its cancer patients for three years through an agreement with Redwood City, California-based Guardant Health, which develops the blood biopsy technology and pays for all the tests.