major breakthrough for earlier detection, picking best treatment individualizing care

[Lani]

Medscape Medical News
Novel Platelet RNA Test Finds Cancer In Single Drop of Blood
Liam Davenport
November 26, 2015

A blood-based platelet RNA test that uses the equivalent of one drop of blood can identify patients with cancer, differentiate between cancer types, and even pick out mutant biomarkers, say European researchers.

In a study published online November 9 in Cancer Cell, the team reports that RNA from "tumor-educated" platelets containing tumor-associated biomolecules could distinguish cancer patients from healthy individuals with an accuracy of 96%.

Furthermore, the test, which may eventually help in cancer diagnosis and guide treatment selection, could differentiate six primary tumor types with an accuracy of 71%, as well as identify specific breast and lung cancer mutant biomarkers.

Coauthor R Jonas A Nilsson, PhD, department of radiation sciences, oncology, Umea University, Sweden, told Medscape Medical News: "Earlier and better diagnosis is a crucial element in curing patients or turning the disease into a manageable, more chronic disease."

"Our technology has the potential to contribute to that goal. It is our objective to show that we can deliver tests that allow costs to be saved at other points in the healthcare system."

The test complements other liquid biopsy tests that detect portions of tumor cell somatic mutant DNA shed into the circulation or released when tumor cells die, which as reported by Medscape Medical News, could allow tumors to be detected, measured, and tracked.

Indeed, two studies in a range of cancer types showed that circulating DNA tests can identify tumors at a very early stage, monitor tumors for metastasis, and even pinpoint treatment resistance. However, these applications are not ready for transfer to the clinic.

Study Details

For their study, Dr Jonas and colleagues isolated blood platelets from 55 healthy donors aged 21 to 64 years, as well as treated and untreated patients with early, localized cancer (n = 39) and advanced, metastatic cancer (n = 189).

The cancer patients included 60 with nonsmall cell lung carcinoma, 41 with colorectal cancer, 39 with glioblastoma, 35 with pancreatic cancer, 14 with hepatobiliary cancer, and 39 with breast cancer.

The team purified 100 to 500 pg of platelet total RNA, the equivalent of less than one drop of blood, for SMARTer mRNA amplification and sequencing.

From that, they identified 5003 different protein coding and noncoding RNAs for subsequent analysis, of which 1453 were increased and 793 decreased in tumor-educated platelets versus samples from healthy donors.

Using a training cohort of 175 patients and an algorithm previously developed to classify primary and metastatic tissues, the team found on ANOVA testing that a panel of 1072 platelet RNAs could identify cancer with a sensitivity of 96%, a specificity of 92%, and an accuracy of 95%.

Clustering of platelet mRNA levels between healthy donors and individual cancer types resulted in a series of tumor-specific gene lists. Using a combination of algorithms based on these lists, the team was able to differentiate between tumor types with an average accuracy of 71% (P < .01).

Finally, researchers examined the ability of platelet RNA profiling to identify specific mutant biomarkers. Although biomarker levels were often low or undetectable, they were able to develop biomarker-specific gene lists for the algorithms.

These were able to distinguish patients with HER2-amplified, PIK3CA mutant and triple-negative breast cancer, and nonsmall cell lung carcinoma patients with MET overexpression (P < .01).

Could Guide Treatment Decisions

Dr Nilsson believes that the test, if proven in further studies, could be used in a number of different ways. He said, "The amount of information we get from the platelet-derived RNA profiles enable the technology to be applied in different diagnostic settings."

"We show it can be powerful in screening applications, but also in guiding primary diagnosis, driving treatment decisions, and longitudinal treatment monitoring," he said.

As the test is also able to distinguish between mutant biomarkers, it could also play an important role in the delivery of personalized cancer care. Dr Nilsson said, "When it comes to personalized cancer care, we may offer an all-in-one solution, from the first time the patient comes in contact with the healthcare system by participating in a screening program ... to making therapeutic stratification based on genetic alterations within the tumor."

Nevertheless, Dr Nilsson and colleagues continue to work on improving the test. He noted that it is "already highly accurate," but added, “we continue to increase the numbers of samples to make the test more robust and accurate.”

When it comes to personalized cancer care, we may offer an all-in-one solution.

Dr Nilsson
"The workflow of the test method is now well-established and further validation, as well as expansion of the repertoire of cancer types, are important next steps."

To those ends, the team are working with numerous groups and setting up studies to validate the findings in the clinical setting, as well as to take into account systemic factors that may affect the platelet mRNA profile, which the authors note may include inflammatory diseases or cardiovascular events and other noncancerous diseases.

"As our technology is easily implemented in the clinical workflow (all labs know how to isolate platelets) and as the results of our work to date have been remarkable, we have been approached by many investigators to collaborate," Dr Nilsson said.

Financial support was provided by grants from the European Research Council, the Netherlands Organisation of Scientific Research, Dutch Cancer Society (Stichting STOPhersentumoren.nl), US National Cancer Institute, CFF Norrland, and Swedish Research Council. Several coauthors are employees of thromboDx.

Cancer Cell. 2015;38(5):666-676. Full text