Monitoring residual disease
Liquid biopsy as an early warning sign for cancer relapse.
For those patients where cancer is detected early, surgery can cure them or dramatically increase their lifespan. However, for example in lung cancer, in around 50% of cases the tumour recurs mainly due to the presence of micro-metastatic disease that is present at the time of surgery but is clinically undetectable.
If we can detect this so-called ‘minimal residual disease’ (MRD) early, there is potential for earlier intervention and more regular check-ups.
Feasibility work was carried out in 2017-2018 including mapping GPs and pharmacies across North Manchester to assess their capabilities in performing study activities. Lloyds Pharmacy was chosen as the community option due to their even distribution across the study area and proactive engagement with CRUK to accommodate the study.
Following this and successfully leveraging additional grant funding from CRUK, an observational cohort study (COMPASS) has opened.
The study invites patients in North and East Manchester who have been treated for lung cancer with either surgery or surgery with adjuvant therapy to give monthly blood samples in their communities.
The blood samples will then be transported to CRUK Manchester Institute Cancer Biomarker Centre’s laboratories where they will be analysed for circulating tumour cells and circulating tumour DNA.
The primary aims of this study are:
- To determine the feasibility/acceptability of regular community-based blood collection in patients after lung cancer surgery to detect MRD from both a scientific and patient perspective
- To determine whether MRD can be detected in blood and predict lung cancer recurrence earlier than standard of care clinical surveillance.
Recruitment is due to begin in Q1 of 2020.
Through our research we will:
- Work with colleagues expert in nanomaterials to increase the sensitivities of liquid biopsies and efficiencies/sample throughput. Once optimised the liquid biopsies will also support our Cancer Prevention and Early Detection, Respiratory and Dermatology research.
- Leverage expertise from our Informatics and Data Sciences colleagues in the integrating patient data/histories with our research.
Progress to date:
- A multidisciplinary team is now established for MRD Monitoring in the community; including surgeons, oncologists, translational scientists.
- Established a partnership with Lloyds Pharmacies across four community pharmacies, with trained phlebotomists covering North & East Manchester
- BRC/CRUK fleet of vans – capacity to collect and deliver blood samples daily, with logged vans to increase public awareness of our cancer research
- Recruiting site activated – Manchester University NHS Foundation Trust
- Health economics – quantify the cost-effectiveness of MRD testing on health outcomes and on costs
- Quality of life assessments – evaluate quality of life and psychological measures in patients after lung cancer surgery, stratified according to route of diagnosis
- Public Patient Involvement Engagement – To increase patient awareness of MRD monitoring and understand patient needs
- Collect, process and bank longitudinal blood samples from patients in community and hospital clinics for future liquid biopsy analyses.
- In parallel, we will modify (as required) and validate our liquid biopsy workflows to increase assay sensitivity and sample throughput.
- Understand patient acceptability and compliance regarding community blood collection for future study designs of community-based MRD monitoring and evaluate patient quality of life/psychological measures.
- On completion of the pilot study, we will launch a clinical trial, to determine whether MRD monitoring with community blood collection and liquid biopsy assessment improves patient outcomes, with the view of rolling out pharmacy based blood collection to more patients.