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Review
. 2023 Nov 17;15(22):5463.
doi: 10.3390/cancers15225463.

The Diversity of Liquid Biopsies and Their Potential in Breast Cancer Management

Corinna Keup  1 , Rainer Kimmig  1 , Sabine Kasimir-Bauer  1
Affiliations
Review

The Diversity of Liquid Biopsies and Their Potential in Breast Cancer Management

Corinna Keup et al. Cancers (Basel). .

Abstract

Analyzing blood as a so-called liquid biopsy in breast cancer (BC) patients has the potential to adapt therapy management. Circulating tumor cells (CTCs), extracellular vesicles (EVs), cell-free DNA (cfDNA) and other blood components mirror the tumoral heterogeneity and could support a range of clinical decisions. Multi-cancer early detection tests utilizing blood are advancing but are not part of any clinical routine yet. Liquid biopsy analysis in the course of neoadjuvant therapy has potential for therapy (de)escalation.Minimal residual disease detection via serial cfDNA analysis is currently on its way. The prognostic value of blood analytes in early and metastatic BC is undisputable, but the value of these prognostic biomarkers for clinical management is controversial. An interventional trial confirmed a significant outcome benefit when therapy was changed in case of newly emerging cfDNA mutations under treatment and thus showed the clinical utility of cfDNA analysis for therapy monitoring. The analysis of PIK3CA or ESR1 variants in plasma of metastatic BC patients to prescribe targeted therapy with alpesilib or elacestrant has already arrived in clinical practice with FDA-approved tests available and is recommended by ASCO. The translation of more liquid biopsy applications into clinical practice is still pending due to a lack of knowledge of the analytes' biology, lack of standards and difficulties in proving clinical utility.

Keywords: blood; breast neoplasm; drug response biomarkers; early detection of cancer; genetic predictive testing; liquid biopsy; precision medicine; prognosis; residual neoplasm.

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Conflict of interest statement

C.K. received support for travel expenses from QIAGEN, Hilden, Germany. R.K. has received honoraria from Tesaro, MSD, GSK and Astra-Zeneca in the last 3 years, is part of the advisory board of Medtronic and council of IGCS and President of SERGS and has proctored and presented for Intuitive Surgical. S.K.-B. is a consultant for QIAGEN, Hilden, Germany.

Figures

Figure 1
Figure 1
Liquid Biopsies for therapy management of BC patients. Different liquid biopsy analytes were evaluated for their suitability for clinical applications over the entire course of the BC disease. The number of references studying the specific blood analytes for the specific clinical BC application is approximated. The sections of this review article discussing the different applications are listed. As the conclusion of this review article, the guidelines and recommendations for the usage of liquid biopsy in each application are summarized. Created with BioRender.com. Abbreviations: cfDNA: cell-free DNA; CTCs: circulating tumor cell: EVs: extracellular vesicle; LB: liquid biopsy; MBC: metastatic breast cancer; MRD: minimal residual disease; NACT: neoadjuvant chemotherapy; TX: therapy.
Figure 2
Figure 2
Liquid Biopsies for therapy management of BC patients. Different liquid biopsy analytes were evaluated for their suitability for clinical applications over the entire course of the BC disease. The references studying the specific blood analytes for the specific clinical BC application are listed. Created with BioRender.com.
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