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Case Study

Keeping a Close Watch on Cancer

Published April 19th, 2021

A cancer diagnosis is scary. And when the cancer has spread to other places in the body, it is often considered incurable – even scarier. However, due to progress in cancer research over the last couple of decades, even cancers that have spread can go into remission or be managed more like a chronic disease. In these scenarios, it is incredibly important to use every tool in our cancer toolbox to monitor for disease progression or recurrence. Cancers in these states can be like smoldering embers, and the sooner we know that the cancer has spread or reignited, the better chance to stomp it out again.

As highlighted in our feature story “Cell-free DNA for non-invasive cancer management and early detection,” an incredibly powerful technology for characterizing cancers, assessing response to treatment, and monitoring for disease progression or recurrence has emerged over the last decade in circulating tumor DNA analysis, or ctDNA (also referred to as cell free DNA analysis). This technology has become a key feature of how we help many of our cancer patients make important decisions about their care. For example, it has been instrumental in keeping our patient Jorge* living a productive, happy life throughout his cancer journey.

Case in Point

Jorge is an otherwise healthy 56-year-old, who came to us in the summer of 2019 with concerning shortness of breath. A rapid, comprehensive work up revealed that his symptoms were due to a gastrointestinal cancer that had spread to his lungs. We knew to help Jorge achieve the very best outcome possible, we needed to make sure he received the most effective treatments available combined with an aggressive monitoring strategy.

Multipronged Monitoring​

We immediately employed two ctDNA analysis approaches to help monitor Jorge’s cancer. The first, called Guardant360, identifies genetic mutations in the cancer that can help point to treatment options and allow monitoring of the response to treatment. The second, called Signatera, is a personalized ctDNA test that can detect a cancer recurrence with extraordinarily high sensitivity, often months before symptoms occur or the cancer can be detected on imaging.

After a surgical procedure to remove as much of the cancer as possible, Jorge endured six months of aggressive chemotherapy. Thankfully, imaging suggested very little, if any, cancer remained, and his Guardant360 test was negative.

Next, to arm his immune system to keep fighting the cancer on its own, Jorge enrolled in an innovative immunotherapy clinical trial where he received a personalized anti-cancer vaccine designed to target his individual tumor cells. Prior to starting the trial, Jorge took both the Guardant360 and the Signatera test again, and both were negative – a great sign that his cancer was well controlled and could be managed as a chronic ailment. Three months later, though Jorge was feeling well and imaging did not reveal any concerning findings, the Signatera test came back positive. This was an early sign that things might not be heading in the right direction. Since immunotherapy can take several months to work effectively, it was decided that Jorge would stay on the trial while continuing to be closely monitored.

As of January 2019, there were an estimated 16.9 million cancer survivors in the United States.

National Cancer Institute

We repeated imaging and both ctDNA tests three months later. This time, imaging results were unable to discern whether changes in his lungs were due to increasing disease or response to vaccine treatment. But, the Signatera test was positive again, this time more strongly than before. Armed with this information, we started planning for next treatment steps in the event that Jorge’s disease continued down this path. In addition, we accelerated our monitoring approach, testing Jorge again two months later. This time, both ctDNA tests came back positive, and imaging indicated disease progression. Because we had that early warning, we were already prepared to quickly pivot to his next treatment. Jorge is responding incredibly well and is currently able to live a full life while managing his cancer.

Progressive & Aggressive Care

Private Health’s research-based and highly personalized care approach empowers us to be progressive and aggressive. We provide this level of care and attention to all our clients when it matters most, changing the trajectory of complex cancers for the better.

* Names changed to protect privacy

* Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

About the Author

Dr. Eva J. Gordon, PhD

Senior Vice President, Research Services

Dr. Gordon has extensive experience as a medical researcher and science writer, with much of her career focusing on cancer and immunology. As a Damon Runyon-Walter Winchell Postdoctoral Fellow at Harvard Medical School, Dr. Gordon studied how viruses evade detection from the immune system.