CNAPS in Therapy Monitoring

Abstract

Monitoring of disease state and of therapy response is highly relevant for efficient patient management. Monitoring tools comprise observation of clinical signs and performing specific examinations such as imaging or blood analyses. This review focusses on the relevance of blood-based biomarker monitoring by circulating nucleic acids for diverse indications that is exemplified on patients who develop or suffer from cancer disease. These indications include (i) screening of patient groups who have a risk to develop a disease, (ii) monitoring response to local or systemic therapies in patients with a defined diagnosis and (iii) early detection of disease recurrence after the primary therapy has ended. Useful biomarkers have to fulfill the highest methodical, pre-analytical and clinical quality criteria and have to be implemented in standardized patient management procedures. The current situation of circulating nucleic acids is summarized on the levels of genetic, epigenetic, transcript, non-coding RNA and nucleosome markers and an outlook is presented as to how these markers can be integrated into a future strategy that enables a personalized management of the patients.

The emerging role of cell-free DNA as a molecular marker for cancer management

“…Importantly, PPVs and NPVs are much more relevant in this context than sensitivity and specificity. Depending on cancer prevalence even markers with high sensitivities and specificities of 90% can have very poor PPVs and create high absolute numbers of false-positive findings [ 203 ] (see Section 5.1.1 . c).…”

“…However, it is clinically more relevant to distinguish between equally aged individuals (with suspicious symptoms) that suffer from an early cancer or a benign disease. In this case the curves will be less optimistic [ 203 ].

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Liquid biopsies in lung cancer—a narrative review

“…They are now well-established in both research and clinical use with an expansion from their original concept of "A test made on a sample of blood to determine the presence of either CTCs or circulating DNA fragments (cirDNA) from a tumor circulating in the blood" (6,7) to one in which a variety of sources in addition to blood, e.g., sputum, saliva, urine, cerebro-spinal fluid, peritoneal fluid, breast milk, tears, bronchial lavage fluid (BALF) and seminal fluid can be exploited. In addition to being used as a marker indicating a tumor presence, this cfDNA may also be used to monitor both treatment management and prognosis (8)(9)(10)(11).…”