Doctors Predict Post-Pandemic Spike in Advanced Cancers: It’s Time to Adopt New Life-Saving Technologies
At the onset of COVID-19, stay-at-home orders were necessary to address an acute public health problem. But the shutdowns had unintended consequences across other areas of healthcare. In particular, they interrupted annual cancer screenings like mammograms and colonoscopies, as well as diagnostic testing for chronic coughs – a possible sign of lung cancer. The impact of these delays is expected to be serious and long-lasting, as many doctors anticipate a post-pandemic spike in advanced cancer diagnoses. We must prepare for this harrowing scenario by accelerating the adoption of new, innovative technologies – like liquid biopsies and precision oncology – to help expedite noninvasive screenings and ensure the best patient treatment.
The New York Times recently highlighted this problem, profiling several patients who had adverse, even deadly, outcomes after being forced to postpone medical appointments. Now an academic study in The Lancet Oncology suggests a clinically significant impact in cancer mortality and life-years lost as the result of prolonged lockdowns in the U.K., which interfered with the country’s 2-week cancer referral pathway. The research finds that the backlog in cancer referrals expected over a 3- and 6-month lockdown would result in hundreds of additional lives lost. Other models predict thousands of excess deaths from breast, colorectal, and lung cancer alone over the next decade.
Effectively treating advanced cancer patients, many of whom have critical diagnoses, requires both precision and speed. The first step must be comprehensive genomic profiling (CGP)– to view the genomic makeup of a person’s cancer and determine if they have a biomarker that makes them a candidate for a personalized medicine, rather than a traditional treatment like chemotherapy.
Unfortunately, sometimes when a patient presents with advanced cancer, there’s a rush to skip CGP and simply start treatment. In fact, only 20 percent of advanced lung cancer and 40 percent of colorectal cancer patients undergo CGP before treatment, leaving too many personalized medicines on the shelves. But when physicians skip CGP, or complete biomarker testing, and a patient receives an ineffective first line therapy, it can be deadly. For example, when a patient with advanced, non-small cell lung cancer receives the wrong first line therapy only 50 percent of patients survive for a second line treatment. Precision medicines, on the other hand, can double or even triple progression-free survival for an advanced cancer patient.
Sometimes physicians skip CGP because they can’t keep up with all the latest pharmaceutical advancements, as the speed in which these personalized drugs are being approved has accelerated dramatically in recent years. In fact, the FDA approved more personalized treatments in 2020 than the last five years combined. More often, however, the reliance on tissue biopsies – the current standard of care – has hindered the adoption of personalized medicine. Tissue biopsies are often risky and invasive and take time – sometimes several weeks – which advanced cancer patients often don’t have.
Fortunately, today we have a reliable alternative: liquid biopsies. These diagnostics can be conducted quickly, through a simple blood draw – and with mobile phlebotomy, even from the safety of a patient’s home. Oncologists at academic facilities have relied on liquid biopsies for years, but many community physicians have been slower to adopt this technology. Last August, the FDA approved two new liquid biopsy tests – including a companion diagnostic developed by Guardant Health – which offer a safer and faster way to conduct CGP. This approval should signal to all oncologists that it’s time to overcome any remaining uncertainty about liquid biopsies and adopt this life-saving innovation and personalized medicines right from the start.
The power of liquid biopsies is undeniable. Right now, as we emerge from the COVID pandemic and begin to address the predicted spike in later-stage cancer diagnoses, liquid biopsies can be used to identify biomarkers and inform personalized treatment plans. Looking ahead, liquid biopsies have the potential to accelerate early detection in their ability to detect circulating tumor DNA in patients with early stage cancer, so that oncologists can address these diseases before they advance and become harder to treat.
Over the past year, we have lost valuable time in detecting and treating deadly cancers. Recent studies continue to suggest that we will witness a dramatic increase in the diagnosis of advanced stage cancers in the months and years ahead. In order to prepare for this post-pandemic wave of late-stage cancer patients, we must work together to accelerate the speed of innovation-to-adoption in oncology, so that we can provide the very best care now and in the future.
Helmy Eltoukhy PhD is the CEO of Guardant Health, a leading precision oncology company whose mission is to conquer cancer through liquid biopsy tests that access molecular data across all stages of the disease.