Leading Thoracic Oncologist, Dr. Christian Rolfo, Explains How Liquid Biopsies Are Advancing Precision Medicine
Dr. Christian Rolfo, President of the International Society of Liquid Biopsy and Associate Director for Clinical Research at the Center of Thoracic Oncology at the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York City, joins us to explain the unique role liquid biopsies are playing in the diagnosis and treatment of cancer.
Dr. Rolfo began by explaining that liquid biopsy is a valuable alternative for gathering genetic information about cancer patients who may not have enough tissue to be tested with a standard tissue biopsy, and he says that liquid biopsies can be performed easily at any stage with a simple blood draw.
Dr. Rolfo says, “You cannot repeat tissue biopsy every time, but you can repeat liquid biopsy very frequently, because what we are doing is just a blood draw. It's minimally invasive and can give us real-time data for monitoring the disease.” He adds that next-generation sequencing or high-throughput sequencing requires the analysis of a large number of genes, which can be difficult to accomplish with a small quantity of tissue.
We asked why more hospitals and clinicians are not regularly using liquid biopsies for this purpose, and Dr. Rolfo is clear that he does not understand the delay. He says that we have the technology, and it is approved and reimbursable, so it is almost unethical not to use liquid biopsy before a treatment is chosen so clinicians have the information they need to understand if a targeted therapy is appropriate.
Precision Medicine Podcast Host, Jerome Madison, points out a finding from the NILE study that shows that cell-free DNA (cfDNA) test, or “liquid biopsy,” identifies more biomarkers and does so more quickly than tissue-based genotyping for guiding treatment in newly diagnosed advanced non–small cell lung cancer (NSCLC). 67% of study participants who had a tissue biopsy had an actionable finding. With liquid biopsy, that percentage rose to 87%. We asked Dr. Rolfo if liquid biopsy should precede tissue biopsy when testing is performed.
Dr. Rolfo believes a complementary approach, using both liquid and tissue, is wise because a very small percentage of cancers may not be detected by liquid biopsy. However, the overall benefit of liquid biopsy, he says, is that it may one day make screening all patients for cancer possible, and that it enables clinicians to test for a wide range of biomarkers. Liquid biopsy is another step towards standardizing early detection, which makes it more likely patients will be prescribed the right precision medicine from the start when it is appropriate.
We asked Dr. Rolfo about the tsunami of information that comes with new technologies like liquid biopsy and how that might impact community oncologists. Dr. Rolfo explains that more community oncologists are currently being supported by larger, academic institutions and what that will mean for the future of precision medicine.
We are grateful for Dr. Rolfo's expert perspective on the important topic of liquid biopsy and encourage all our listeners to tune in.
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About Our Guest
Dr. Christian Rolfo
President of the International Society of Liquid Biopsy
Associate Director for Clinical Research at the Center of Thoracic Oncology at the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York City
Christian Rolfo, MD, PhD, MBA, Dr.hc. is Professor of Medicine (Hematology and Medical Oncology) and Associate Director for Clinical Research in the Center for Thoracic Oncology at The Tisch Cancer Institute. Dr. Rolfo’s clinical and research focus is on drug development, lung cancer and other thoracic malignancies, biomarkers, resistant mechanisms discovery, and liquid biopsies. Dr. Rolfo has held academic appointments at numerous institutions, including the University of Cordoba, Argentina; University of Antwerp, Belgium; University of Palermo, Italy, and the University of Maryland and Greenbaum Comprehensive Cancer Center where he was Director of Thoracic Medical Oncology and Director of Early Clinical Trials. Dr. Rolfo earned his MD at the University of Cordoba School of Medicine, his PhD and Doctor Europaeus in Clinical and Experimental Oncology Research at University of Palermo, Italy, and an MBA in Hospital and Health Services Management and Organization at Polytechnic University of Valencia, Spain. He completed residency training in Medical Oncology at the National Cancer Institute in Milan (University of Milan, Italy).
Dr. Rolfo is President of the International Society of Liquid Biopsy (ISLB) and Chair of the Education Committee at the International Association for Study of Lung Cancer (IASLC). Dr. Rolfo served as member of the Drug Approval & First in Human Commission at the Ministry of Health in Belgium during his time as Phase I Director at Antwerp University.
Dr. Rolfo is actively working on drug development and lung cancer and mesothelioma treatment. His research is focused in molecular oncology, targeted therapies and Immunotherapy in thoracic oncology using new techniques in liquid biopsies, specifically in extracellular vesicles and circulating free tumor DNA. His research group identified ALK translocation in exosomes in NSCLC patients, and showed, for the first time, the videos of labeled EVs uptake by living lung cancer cells. He is currently working on the identification of new biomarkers involved in immunotherapy and TKI drug-resistance and early detection of lung cancer with liquid biopsy. Dr. Rolfo has contributed to the development of several compounds including Erlotinib, and the pharmacokinetics of Olaparib, Entrectinib, Selpercatinib, Trastuzumab Duocarmazine, among others.
Dr. Rolfo has authored more than 250 scientific articles, has made several contributions to book chapters, and has served as a book editor. He has published extensively in peer-reviewed journals including New England Journal of Medicine, Lancet Oncology, Cancer Discovery, Nature Clinical Reviews in Oncology, Journal of Thoracic Oncology, Nature Nanotechnology, Clinical Cancer Research, Annals of Oncology, and Lung Cancer among others. Dr. Rolfo is Editor in Chief of Critical Review in Oncology Hematology and Associate Editor at ESMO Open.