Liquid Biopsies Are More Feasible, Appropriate for ESR1+ Breast Cancer
Using liquid biopsies to test for ESR1 mutations in breast cancer is more feasible for patients and has quicker turnaround times.
Using liquid biopsies to test for ESR1 mutations in breast cancer can make testing more comfortable and produce a quicker lab turnaround time for patients, said an expert.
In an interview with Oncology Nursing News following a Community Case Forum, Jamie Caroll, APRN, CNP, MSN, explained that a key takeaway of the event is the increased feasibility of liquid biopsies compared to tissue biopsies. As Caroll stated, liquid biopsies can be added to a more routine blood test and reduce additional discomfort for patients.
Taking advantage of liquid biopsies can be an opportunity for nurse practitioners (NPs) and physician assistants (PAs) in oncology to avoid the discomfort of ultrasound-guided needle biopsies. This also reduces processing times, which can take even a month for tissue biopsies, as well as cost for patients.
Caroll emphasized that understanding the utility of liquid biopsies is important not just for oncology advanced practice providers (APPs), but for nurses as well. She shared that APPs who attended the event sharing the key takeaways will benefit the team as a whole.
Transcript
The main takeaway is the use of the companion diagnostic and using liquid biopsy as the preferred method because I think historically, people use tissue biopsy most often when looking at next-generation sequencing, and so ensuring that they’re thinking about liquid biopsy.
I think the challenge is that the NPs and PAs in the community are not seeing restaging patients. So their level of interaction with deciding next line of therapy or ordering [testing from Guardant or Tempus], whatever the genomic testing is, they don’t have oversight there, so the [medical doctors; MDs] on their team are the ones that are seeing the patients, and then [NPs and PAs] see them for their toxicity checks or their surveillance visits.
So my hope is that they would have increased knowledge from the Community Case Forum and they’re able to bring that back to even the team, because it doesn’t necessarily have to be the MD. It could be the clinical nurse that they’re working with. And maybe the MD asked the clinical nurse, “Hey, can you order a Tempus?”
And then the clinical nurse says, “Hmm, I talked to the NP or PA. They went to a Community Case Forum last night, and we could be using liquid biopsy.”
The feasibility of liquid biopsy, it’s a lot easier. You’re getting other blood testing, and so you just order that liquid biopsy at the same time, the patient doesn’t need additional pokes, [it causes] less cost to the patient, whereas tissue biopsy does take longer to come back, you have to pre-plan liver biopsy, bone biopsy, and those can take up to a month to result.
Also, there’s other factors that come into play if you’re doing a liver biopsy and the patient’s on anticoagulation because they have a history of a clot. Now you’re looking at, “Do I need to bridge them with anticoagulation into low molecular weight heparin?”
So there’s more logistics that come into it than that. Oftentimes it’s another visit for a patient, and it depends on how far our patients are traveling to get to your institution.
If it’s just a liquid biopsy, you just send them down to the lab and they get it done, but if it’s a tissue, you can’t just send them real quick over to ultrasound and they’re going to do an ultrasound-guided needle biopsy at that time. It’s going to be another visit for the patient to come back, and then results do take longer.
We know based on data that ESR1 mutations are acquired, and they are acquired longer after patients have been on endocrine therapy, so [for] a patient that’s early stage, the rates of ESR1 mutation is 0%. Once the patient becomes metastatic, those rates are still really low, 4-5%.
The really important time to test for an ESR1 mutation is when a patient is progressing on first-line, metastatic therapy. So right before you’re going to put them on second line is when you should be testing. And then patients can have up to a 30-40% chance of having an ESR1 mutation.
This transcript has been edited for clarity and conciseness.
