According to the Krebsinformationsdienst (Cancer Information Service), around 493,200 people are diagnosed with cancer each year. Hope in the fight against this disease is provided by research results that, above all else, point towards individualised therapy. Liquid biopsy is a kind of milestone in tumour diagnostics and personalised approaches to treatment. With this process, the characteristics of a tumour can be detected in the blood such that the tumour itself does not have to be biopsied.

A long-term study is now being conducted at the Faculty of Medicine at the University of Augsburg that aims to test the application of this now mature and well-tested procedure in everyday clinical use. The initial results have been published in the Journal of Laboratory Medicine. “We have succeeded in impressively demonstrating the applicability of this very innovative method of liquid biopsy in the context of routine clinical care,” says Dr Maximilian Schmutz, first author of the recently published results.

Diverse information in small drops of blood

The “Augsburg Longitudinal Plasma Study (ALPS)” accompanies people with cancer throughout their therapy at the University Hospital Augsburg. “With this highly innovative and simultaneously easy to implement and minimally invasive treatment method, we can gain very important insights into the course of the disease during a patient’s treatment,” explains Prof. Dr Rainer Claus, professor for personalised tumour medicine and molecular oncology, who is leading the study together with Prof. Dr Martin Tepel, professor for internal medicine, haematology, and oncology. “With liquid biopsy we can find parts of tumour DNA in the patient’s blood without the need for any further intervention,” says Trepel.

A few millilitres of blood are taken from the study participants each time they come to the hospital for cancer therapy. Liquid biopsy can provide their doctors with diverse information about the genetic make-up of the tumours and therefore about the course of the disease. The blood sample, like a tissue sample, contains parts of the tumour’s genetic material which, as so-called biomarkers, help to characterise the tumour and assess both the prognosis and possible responses to therapy. The genetic information of individual tumour cells provides a great deal of valuable information.

Highly sensitive detection methods at the molecular level

“The tumour components allow us to make more precise statements about disease prognosis. We can observe how the genetic material of the tumour changes during the course of treatment and adapt our medication and treatment accordingly. We can also see where resistance is emerging,” says Schmutz. Using liquid biopsy, treating physicians can also obtain information about tumour metastases at other locations in the body that cannot be reached with a conventional tissue biopsy – and at a very early stage.

This is made possible by highly sensitive detection methods at the molecular level. New, highly sensitive methods of DNA sequencing, i.e., the breakdown of genetic information, pave the way for liquid biopsy because tumour DNA and cells are only found in small quantities in the blood.

One of the challenges of assessing the feasibility of the procedure in everyday clinical practice is not only using liquid biopsy over a longer period of time, but also linking it with comprehensive patient data, e.g., from imaging procedures, laboratory values, etc., and testing it in real everyday hospital practice with all its processes. “This is the only way that we can gain comprehensive information about how tumours change during therapy and find out what is needed to apply liquid biopsy across a broad scale in the future and evaluate its value in everyday clinical practice,” says Martin Trepel.

Still possible to participate in the study

Researchers in the ALPS study are also investigating how well the analysis of the genetic material of tumours from blood samples corresponds with a classic tissue biopsy. “Hopefully, we will be able to dispense with some of the tissue samples in future, or at least supplement them with essential information on the molecular composition of the disease as a whole, even beyond the small biopsied area,” says Rainer Claus, looking into the future.

Another aim of the ALPS study is to establish a collection of liquid biopsy samples for future scientific purposes and investigations. The samples will be linked to the corresponding medical data at the Augsburg Central Biobank at the University Hospital Augsburg and will be available to researchers for further projects upon request.

For further information on participating in the study:
https://www.uk-augsburg.de/fileadmin/Daten/Zentren/z-Cancer_Center/Dateien/Klinische_Studien_alps_v01-08.2021_final.pdf

To the article

>> Sommer, Sebastian, Schmutz, Maximilian et.al. “Concept and feasibility of the Augsburg Longitudinal Plasma Study (ALPS) – a prospective trial for comprehensive liquid biopsy-based longitudinal monitoring of solid cancer patients” Journal of Laboratory Medicine, vol. 48, no. 3, 2024, pp. 107–119.

>> https://doi.org/10.1515/labmed-2023-0156