Dr. Anagnostou on Using Liquid Biopsies to Monitor Reponses to Immunotherapy in NSCLC

Valsamo Anagnostou, MD, PhD, of the Johns Hopkins University School of Medicine, discusses advancements in the use of liquid biopsy in lung cancer and her team’s research on the topic.

“We are focusing on the development of liquid biopsy approaches and the implementation of liquid biopsy approaches in clinical cancer care,” she said. “The field of liquid biopsy is a very exciting field with respect to development of new technologies that allow the very sensitive detection of tumor DNA remnants in the peripheral blood.”

Dr. Anagnostou explained that her team is “working toward the implementation of these exciting technologies in clinical cancer care.”

“We’re using these minimally invasive approaches to help us make decisions in terms of how we treat our patients, in terms of how to identify patients with cancer [who] are at higher risk for disease recurrence, how we track tumor burden during therapy, how we monitor a therapeutic response,” she said. “Certainly, liquid biopsies are now emerging as an exciting opportunity that can be implemented across the clinical cancer care continuum, and it’s really exciting to see the clinical validation and the clinical implementation of those approaches.”

Dr. Anagnostou, who previously published a highly cited article titled “Evolution of Neoantigen Landscape during Immune Checkpoint Blockade in Non–Small Cell Lung Cancer,” spoke about her specific area of research on liquid biopsies and the historic challenges that she hopes to overcome.

“Our area of focus is tracking response to immunotherapy for patients with advanced cancers, with cancers that are spreading in the body,” she said. “This has been historically very challenging … we typically do this by just imaging … in the context of immunotherapy, we know that these measurements on imaging, they’re just inaccurate.”

It’s important to recognize that imaging, which is the “gold standard” for assessing response to therapy, “doesn’t capture the unique nature and timing of immunotherapy response,” Dr. Anagnostou emphasized. She explained how the liquid biopsy approach may be able to address this issue.

“What we truly need to do is implement minimally invasive approaches that can very accurately and in real time capture tumor burden and then help us make therapeutic decisions,” Dr. Anagnostou said.

She also spoke about her recent research on circulating tumor DNA (ctDNA) in non-small cell lung cancer (NSCLC) that she presented during the American Association for Cancer Research (AACR) Annual Meeting 2024.

“We’ve been employing very sensitive approaches … to actually track mutations in the circulation of patients with cancer and track them over time and then identify specific profiles that may be associated with therapy response, tumor regression and imaging, or tumor expansion and extension on imaging,” Dr. Anagnostou said. “And what we found is that in the context of immunotherapy, they’re actually very distinct profiles with respect to ctDNA—or circulating tumor DNA—dynamics that are actually reflective of patients’ clinical outcomes.”

She explained the future of this line of research and what could be on the horizon for the use of these liquid biopsy approaches.

“Certainly, there is extension of these approaches now to the early-stage disease setting … this is very relevant, as immunotherapy [has] now moved from the metastatic paradigm to the early disease treatment armamentarium, and so we truly, truly need those very sensitive nuanced molecular assays to dissect the clinical responses that that we see with immunotherapy,” Dr. Anagnostou concluded.