BioMed Research International / 2016 / Article / Fig 1

Review Article

Clinically Meaningful Use of Blood Tumor Markers in Oncology

Figure 1

Integration of TMs with other diagnostic modalities, as exemplified in the management of lung cancer. Using a panel of different TMs will guide the decision to either observe a patient with an indeterminate lung nodule versus proceed with a biopsy. In this example, levels of CYFRA 21-1 are elevated. Tissue diagnosis with IHC establishes the diagnosis of adenocarcinoma NSCLC, and molecular testing shows an actionable EGFR mutation. On imaging, an advanced stage is confirmed, and a treatment decision is made based on the integrated information. During treatment (in this case with a tyrosine kinase inhibitor [TKI]), response can be monitored with serial CYFRA 21-1 measurements showing a decline, thus replacing interim staging imaging. Upon rise of the CYFRA 21-1 levels, repeat imaging is performed, which confirms progressive disease. A liquid biopsy avoids an invasive procedure and testing of cell-free DNA by PCR shows the development of a resistant mutation. Based on the result, a second line TKI is chosen. Treatment response is then again monitored using TMs. DDX, differential diagnosis.