Winter 2017

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PATRONS | Winter 2017 16 C ancer treatments rely on biopsies—the removal of cells or tissue for examination by a pathologist—for definitive diagnosis. Biopsies are invasive, sometimes to the point of requiring surgery. A new type of biopsy, under investigation at Torrance Memorial Physician Network–Cancer Care (a medical group affiliated with the Hunt Cancer Institute at Torrance Memorial Medical Center), is paving the way to become a much less invasive method to detect and treat cancer. Known as liquid biopsies, these are blood tests that analyze pieces of tumor DNA or other genetic material "shed" from tumor cells circulating in the blood. Oncologists with Torrance Memorial Physician Network–Cancer Care are partnering with liquid biopsy companies to develop these new blood tests that can detect cancer and also help direct treatment. One of these research clinical trials is a national multi- center feasibility trial in partnership with a company called Genomic Health. "We are the leading research group for Genomic Health in developing a DNA/RNA blood test to diagnose breast cancer at a very early stage in its development," says David Chan, MD, medical oncologist with Physician Network– Cancer Care and the program director for oncology with the Torrance Memorial Hunt Cancer Institute. "If successful, this test would also be helpful in monitoring the progress of breast cancer patients." So far 370 breast cancer patients have donated their time and blood specimens over the past two years for this trial's data points. e promise of the trial is great—it gives doctors the ability to have an extremely accurate blood test to monitor disease status in a breast cancer patient. A similar trial underway in the oncology program is working with another biotech company, Natera, to develop a liquid biopsy for the early detection of lung cancer in patients with lung nodules. Dr. Chan notes that in their diagnostic center they find around 500 lung nodules on computerized tomography (CT) scans every year. e nodules may be from previous lung infections or scarring and not necessarily cancer, but patients generally need repeat scans and sometimes biopsies to determine the cause. Currently lung nodule patients are donating blood specimens to help in the development of a DNA/RNA test to diagnose whether the nodules are due to cancer or are benign. If effective, this could prevent the need for multiple scans and invasive biopsies to detect a malignancy. TARGETED GENE TREATMENT Detection is just one of the hopes for liquid biopsies. Another is identifying specific genetic markers or mutations that can help physicians choose the most appropriate course of care. "When an oncologist can find an actionable mutation (i.e., a mutation for which there is an available targeted therapy), this can open up brand new treatment options for patients," says Andrew Horodner, MD, medical oncologist with Torrance Memorial Physician Network–Cancer Care and chairman of the tumor board and vice chair of the oncology committee with the Torrance Memorial Hunt Cancer Institute. Typically an oncologist employs chemotherapy against cancer. While often effective, the therapies can be toxic, notes Dr. Horodner. Chemotherapy acts on all actively dividing cells, so it can adversely affect multiple organs. In contrast, "erapies that hit a specific target in the cancer cell are more focused and generally better tolerated due to fewer side effects," says Dr. Horodner. "Many targeted therapies are WRITTEN BY BRIE CADMAN | PHOTOGRAPHED BY SHANE O'DONNELL LIQUID BIOPSIES PROMISE DETECTION AND TARGETED TREATMENT. The Cutting Edge of Cancer Research

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