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Essential Guide to Cancer Biomarkers For Cancer Patients

Updated: Apr 23


Dr. Rolfo explains cancer biomarkers to patient, Terri Conneran. Full Video


Dr. Christian Rolfo MD PhD MBA Dr.hc (about)

Division of Medical Oncology at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).


Christian Rolfo, MD, PhD, MBA, Dr.hc. is the Division Director of Medical Oncology and Associate Director for Early Phase Clinical Trials at The James Comprehensive Cancer Center, The Ohio State University. He served as Professor of Medicine (Medical Oncology) and Associate Director for Clinical Research in the Center for Thoracic Oncology at The Tisch Cancer Institute from 2021 to 2024. 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 CCC 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 Italy


Dr. Rolfo is President of the International Society of Liquid Biopsy (ISLB) Dr. Rolfo served as member of the Drug Approval & First in Human Commission at the Ministry of Health in Belgium. 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. EVs PD-L1 dynamics as biomarker for immunotherapy . Dr. Rolfo has contributed to the development of several compounds including Erlotinib, and the pharmacokinetics of Olaparib, Entrectinib, Selpercatinib, Trastuzumab Duocarmazine, among others.He has authored more than 350 scientific articles & contributions to book chapters. He has published extensively in peer-reviewed journals including New England Journal of Medicine, Lancet Oncology, Cancer Discovery, Nature Clinical Reviews in Oncology, JTO, Clinical Cancer Research, Annals of Oncology, among others. Dr. Rolfo is Editor in Chief of Critical Review in Oncology Hematology.




Introduction to Cancer Biomarkers

  • Terri Conneran (KRAS Kickers founder Hosts Dr. Christian Rolfo, a medical expert in biomarkers.

  • Terri Conneran emphasizes Dr. Rolfo’s brilliance and grace in the field of cancer research.

  • Dr. Rolfo's Remarks:

    • Dr. Rolfo expresses gratitude and acknowledges the critical role of patient voices in cancer research.

    • The importance of biomarkers and their impact on patient outcomes is discussed.

What is a Biomarker?

  • Definition of a Biomarker:

    • Biomarkers are measurable biological factors, such as genetic mutations.

    • Key types: Germline mutations (inherited) vs. Somatic mutations (develop during life).

  • Somatic Mutations:

    • These mutations provide insights into cancer behavior, aggressiveness, treatment options, and resistance mechanisms.

Types of Biomarkers

  • Diagnostic Biomarkers:

    • Help determine the type of cancer.

  • Prognostic Biomarkers:

    • Assess the likely course of the cancer. Example: KRAS mutations can indicate more aggressive cancer.

  • Predictive Biomarkers:

    • Predict how well a patient will respond to a treatment.

  • Therapeutic Biomarkers:

    • Track how a treatment is working for a patient.

  • Safety Biomarkers:

    • Monitor side effects of treatments, sometimes identified through liquid biopsies.

  • Long-term Monitoring:

    • Help track cancer relapse and resistance mechanisms.

Tests for Biomarkers

  • Biomarker Testing Methods:

    • Tissue Biopsy:

      • Involves taking a sample of the tumor.

      • Technologies like NGS (Next-Generation Sequencing) are used to identify genetic mutations.

    • Liquid Biopsy:

      • Less invasive (blood sample) and can provide dynamic, real-time monitoring of cancer.

      • Useful for tracking mutations that may be missed in tissue biopsies.

  • Challenges with Testing:

    • Tissue samples may not represent the entire tumor, leading to incomplete genetic information (heterogeneity of tumors).

    • Liquid biopsy can complement tissue testing and help identify mutations in real-time.

Liquid Biopsy

  • How Liquid Biopsy Works:

    • Involves capturing circulating tumor DNA (ctDNA) in the blood.

    • It is minimally invasive and can be repeated over time for monitoring.

  • Advantages Over Tissue Biopsy:

    • Repeated testing without the discomfort of a tissue biopsy.

    • Helps track tumor evolution and identify resistance mechanisms as cancer progresses.

  • Challenges:

    • Some tumors may not shed enough DNA into the bloodstream for liquid biopsy to be informative (non-shedders).

    • Technology limitations can lead to false negatives, especially in early cancer detection.

Biomarker Testing in Cancer Types


    • Lung Cancer:

      • Liquid biopsy has been particularly effective for monitoring lung cancer due to the high shedding of DNA.

    • Other Cancers:

      • While liquid biopsy is promising for various cancers, it’s not yet perfect, especially in detecting minimal residual disease.

 Treatment Strategies - Based on Biomarkers

  • Treatment Adaptation:

    • Personalized treatment strategies can be tailored based on the biomarkers identified.

    • Example: EGFR mutation in lung cancer can be targeted with specific drugs like osimertinib.

  • Challenges in Resistance:

    • Over time, tumors may develop resistance to treatments, requiring adjustments in therapy.

  • Combining Treatments:

    • In some cases, multiple mutations or biomarkers may require the use of combination therapies to effectively target cancer.

 Patient Questions & Discussions


    • Understanding the Testing Process:

      • Patients are encouraged to ask their healthcare providers about biomarker testing.

      • The importance of comprehensive testing to understand the cancer’s genetic makeup is emphasized.

    • Interpreting Biomarker Results:

      • Results can vary, and understanding the implications of these results on treatment options and prognosis is crucial.

      • Some tests are better suited for certain cancers or treatment regimens.


    • Technological Advancements:

      • Continuous improvements in liquid biopsy technology are expected, enhancing its sensitivity and accuracy.

    • Challenges Ahead:

      • Despite progress, early-stage detection and some rare mutations still present challenges.

      • Ongoing research aims to address these issues and provide better tools for personalized cancer treatment




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