IJzerman Maarten J, de Boer Jasper, Azad Arun, Degeling Koen, Geoghegan Joel, Hewitt Chelsee, Hollande Frédéric, Lee Belinda, To Yat Ho, Tothill Richard W, Wright Gavin, Tie Jeanne, Dawson Sarah-Jane
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne Centre for Cancer Research, Parkville, VIC 3000, Australia.
Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Population and Global Health, Parkville, VIC 3053, Australia.
Diagnostics (Basel). 2021 Jan 11;11(1):103. doi: 10.3390/diagnostics11010103.
Blood-based liquid biopsies are considered a new and promising diagnostic and monitoring tool for cancer. As liquid biopsies only require a blood draw, they are non-invasive, potentially more rapid and assumed to be a less costly alternative to genomic analysis of tissue biopsies. A multi-disciplinary workshop ( = 98 registrations) was organized to discuss routine implementation of liquid biopsies in cancer management. Real-time polls were used to engage with experts' about the current evidence of clinical utility and the barriers to implementation of liquid biopsies. Clinical, laboratory and health economics presentations were given to illustrate the opportunities and current levels of evidence, followed by three moderated break-out sessions to discuss applications. The workshop concluded that tumor-informed assays using next-generation sequencing (NGS) or PCR-based genotyping assays will most likely provide better clinical utility than tumor-agnostic assays, yet at a higher cost. For routine application, it will be essential to determine clinical utility, to define the minimum quality standards and performance of testing platforms and to ensure their use is integrated into current clinical workflows including how they complement tissue biopsies and imaging. Early health economic models may help identifying the most viable application of liquid biopsies. Alternative funding models for the translation of complex molecular diagnostics, such as liquid biopsies, may also be explored if clinical utility has been demonstrated and when their use is recommended in multi-disciplinary consensus guidelines.
基于血液的液体活检被认为是一种新型且有前景的癌症诊断和监测工具。由于液体活检仅需采集血液，所以它是非侵入性的，可能更快，并且被认为是组织活检基因组分析成本更低的替代方法。组织了一次多学科研讨会（98人注册）来讨论液体活检在癌症管理中的常规应用。通过实时投票与专家探讨液体活检临床应用的现有证据以及实施过程中的障碍。会上进行了临床、实验室和卫生经济学方面的报告，以说明机会和当前的证据水平，随后进行了三场有主持人的分组讨论以探讨应用。研讨会得出结论，使用下一代测序（NGS）或基于PCR的基因分型检测的肿瘤知情检测方法很可能比肿瘤非特异性检测方法具有更好的临床实用性，但成本更高。对于常规应用，确定临床实用性、定义检测平台的最低质量标准和性能并确保其使用融入当前临床工作流程（包括它们如何补充组织活检和成像）至关重要。早期卫生经济模型可能有助于确定液体活检最可行的应用。如果已证明临床实用性且多学科共识指南推荐使用液体活检等复杂分子诊断方法，也可以探索替代的资金模式。
