Systematic liquid biopsies are transforming treatment approaches for patients with gastrointestinal (GI) cancers. Many GI tumors are detected late, which ultimately reduces 5-year overall survival rates. Liquid biopsies may become increasingly important both in the early detection and treatment spaces to advancing GI cancer care.
One innovator in the GI cancer research space is Aparna Parikh, MD, MS, a medical oncologist at Massachusetts General Hospital Cancer Center. Dr. Parikh’s research focus is on the usefulness of liquid biopsies as tools for personalizing patient care plans.
Aparna Parikh, MD, MS
Potential Benefits of Liquid Biopsies
Using support from a Career Development Award funded by Conquer Cancer, the ASCO Foundation, and Stand Up To Cancer, Dr. Parikh launched a national clinical trial (NCT03803553) investigating the efficacy of liquid biopsies to treat patients with stage III colon cancer and predict which patients are at the highest risk of recurrence. She expects liquid biopsies to complement the course of care by functioning as guides that reveal whether certain treatments can effectively remove ctDNA (tumor-derived DNA). Liquid biopsy data can indicate which patients are at greater risk of recurrence and therefore may need more therapy. This could inform patient-centered care decisions and significantly improve outcomes.
Liquid biopsy data can indicate which patients are at greater risk of recurrence and therefore may need more therapy. This could inform patient-centered care decisions and significantly improve outcomes.
“If we can show liquid biopsies can not only predict recurrence but that treatment can ‘clear’ ctDNA, it will transform the way we care for patients with resected disease but who are still at risk for recurrence,” Dr. Parikh said. “Based on the liquid biopsy, [we can] offer them more therapy, often personalized, which we hope will increase cure rates for patients.”
In a separate trial, Dr. Parikh is studying whether liquid biopsies can predict how patients with metastatic GI cancers will respond to treatment. Preliminary data reveals ctDNA can predict treatment response, and oncologists can use these findings to personalize care plans based on how patients may respond to certain therapies. Most promising, this process could spare patients from toxic treatments that are unlikely to work.
“We hope that through this research eventually we can more accurately tailor treatment and provide patients the best care possible,” Dr. Parikh said.
Multiple Avenues of Inspiration
Personal experiences inspire Dr. Parikh to make research progress and improve outcomes for patients and families affected by GI cancers. She lost her uncle, and a friend who also happened to be an oncologist, to gastric cancer.
“I see so many young patients with their whole lives ahead of them,” Dr. Parikh said. “I hope to be a part of the success story in honor of my loved ones, my patients, and their families.”
Dr. Parikh draws motivation from many experiences. She reflects on one experience with a late patient’s partner that stands out. A few months after her patient passed, their spouse travelled to her clinic from out of state for a surprise visit.
“I was perplexed. They weren’t local, and we had some challenges with our therapeutic relationship, especially toward the end. The spouse said, ‘I know Wednesdays are your busiest days, so I drove up to Boston because I needed to see you and to thank you, and I wanted a hug,’” Dr. Parikh said. “We embraced, both of us crying. It was such a powerful moment.”
This experience reminds Dr. Parikh that advancements in cancer research occur in meaningful increments. Small steps made from clinical trials can enable oncologists to optimize care, improve quality of life, help patients reach their unique care goals, and maximize the time patients have with their loved ones.
Dr. Parikh credits the Career Development Award for providing her with resources like protected research time to “develop and nurture ideas that we hope will be transformative for patients,” she said. The award also connected her with mentors invested in her professional growth as a GI cancer researcher. Having a network of support helps Dr. Parikh plan next steps for patient-centered clinical studies.
Despite the COVID-19 pandemic, Dr. Parikh’s Conquer Cancer-funded trial is enrolling and well underway. She anticipates results will complement ongoing stage II and oligometastatic studies by informing best practices for integrating liquid biopsies into the adjuvant setting. Such innovations to GI cancer care provide a potential strategy for reducing patient risk of reoccurrence. This may mean better outcomes for patients everywhere and hopefully increase cure rates.
“We are also interested in whether liquid biopsies can help us guide adjuvant therapy for patients with metastatic disease who are undergoing curative intent resections and I hope we can eventually conduct trials in this space as well,” Dr. Parikh said.
She also plans to build on her liquid biopsy work by researching whether using ctDNA as an early biomarker of response can ultimately improve patient outcomes. And Dr. Parikh holds patients at the heart of all she does to conquer cancer.
“We need to move the needle for these patients,” Dr. Parikh said. “There is nothing more gratifying than when you see a patient benefitting from your research, and I strive for equity in cancer care for all patients.”
Originally published in ASCO Daily News. © American Society of Clinical Oncology. ASCO Daily News, October 22, 2020. All rights reserved.