Liquid Biopsy for Solid Tumors Also IDs Risk for Blood Cancer

A liquid biopsy that is currently used for molecular profiling in patients with solid tumors can also identify patients who are at high risk of having a clonal hematopoiesis, according to results from the STING study.

“Clonal hematopoiesis may represent a premalignant state for myeloid cancers,” commented study author Marco Tagliamento, MD, Gustave Roussy, Villejuif, France.

“And we showed that liquid biopsy can be useful to select patients with solid tumors who may benefit from a personalized hematologic care after the detection on liquid biopsy of high-risk clonal hematopoiesis,” he emphasized.

Tagliamento was speaking at a press briefing before presenting the study at a meeting in Barcelona, Spain, held jointly by the European Organisation for Research and Treatment of Cancer, the National Cancer Institute, and the American Association for Cancer Research (EORTIC-NCI-AACR).

Occult Myeloid Malignancies

The study involved 1416 patients with advanced solid tumors. Some of the patients had received treatment for their cancer, and some had not. Each patient underwent at least one liquid biopsy with next-generation sequencing of cfDNA performed by FoundationOne Liquid CDx.

“The aim of the study was to detect occult early myeloid malignancies in patients with solid tumors who underwent a liquid biopsy for molecular profiling of their tumor,” Tagliamento explained.

In cases in which the liquid biopsy identified mutations in JAK2 or MPL, patients were referred for a hematology consultation. At a median follow-up of 9.6 months, 8% of these patients carried at least one clonal hematopoiesis mutation considered to be associated with high risk of developing a myeloid hematologic disorder.

These included two patients with myelodysplastic syndrome, two with essential thrombocythemia, and one with chronic myelomonocytic leukemia.

“All [these] patients received hematologic care,” Tagliamento noted.

The authors concluded that “incidental findings of clonal hematopoiesis via liquid biopsy may trigger additional hematological tests revealing risk for developing myeloid malignancy or uncovering occult disease.”

Tagliamento also emphasized that detecton could prevent complications during cancer therapy that might otherwise interrupt or delay treatment.

Commenting on the findings, Ruth Plummer, MD, clinical professor of experimental cancer medicine, Newcastle University Centre for Cancer, United Kingdom, who was chair of the meeting, noted that this study was well conducted and reveals an additional facet to the information gained from liquid biopsies.

“This study suggests patients with these mutations should be referred for further evaluation,” she said.

However, she noted that “decisions about what would be best for these patients will depend on a range of other factors.,” Plummer said.

“Cancer patients have much to worry about, so doctors need to take into account the patient’s clinical situation and their treatment plan,” Plummer commented.

Because patients are often very anxious about the cancer they have already been diagnosed with, it may not always be appropriate to highlight a potential increased risk of developing an additional hematologic malignancy in the future, she cautioned.

“Only some specific clonal hematopoiesis mutations are likely to predict a higher risk of blood cancer developing at some point in the future,” she emphasized.

Tagliamento has received travel and accommodation expenses from Roche, Bristol-Myers Squibb, AstraZeneca, Takeda, and Eli Lily. He also has received honoraria from Novartis, Amgen and Merck Sharp Dohme.

EORTIC-NCI-AACR 34th Annual Meeting: Abstract 22. Presented October 28, 2022.

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