Cancer is an increasing burden on the health system and projected incidence figures – that 1 in 2 of us born after 1960 will be diagnosed with some form of cancer – make for gloomy reading. However, a combination of technological leaps and marginal gains have led to greatly improved survival figures for many cancers; with now 80% of patients surviving more than 10 years post diagnosis for breast cancer, compared to 40% in the 1970s.

Better diagnosis, more refined treatments and more recently precision medicines, which target very specific features of a patient's tumour, are behind the improvement in survival figures for some cancers. There are many areas of technological innovation currently being pursued to further improve cancer management, such as more precise radiotherapy techniques, more refined surgery, improved medical scanning technologies, in addition to new therapies including immunotherapy and biological therapy.

Targeting areas of unmet clinical need

But improved survival is not consistent across cancers – for some cancers such as lung and pancreas, survival rates have stayed stubbornly low and have not changed in the past 40 years. One of the key questions emerging with the adoption of innovative technologies in the NHS is how we can realise the benefits of these new technologies in these areas of unmet need - improving patient access to precision medicines, and ultimately improving survival rates.

Technologies which analyse circulating tumour DNA (ctDNA) in the bloodstream of patients (ctDNA liquid biopsies) could help improve cancer management in lung cancer. These ctDNA technologies are currently being implemented in a small subset of lung cancer patients, potentially opening up the option of new therapies better suited to their tumours. PHG Foundation have found that although ctDNA testing has clinical utility for lung cancer patients, much needs to be done to develop services and infrastructure so that all lung cancer patients can access these services, no matter where they live.

Identifying challenges and supporting implementation

In this first of a series of briefing notes on ctDNA technologies, Circulating tumour DNA technology: the future of cancer management, we outline what the technology is, its potential uses and also its disadvantages, including what is needed to maximise the utility of the technology. Although promising, this technology is not a panacea for many of the challenges that affect the management of cancer, but now, and in the immediate future, it will have an important role to play in informing treatment decisions in non-small cell lung cancer, colorectal cancer and melanoma. 

ctDNA testing is an exciting area and the development of ctDNA testing services will provide us with many useful lessons for how to make best use of innovative technologies for the benefit of patients. We want to make sure those lessons are not missed and will be bringing together experts from a wide range of relevant fields to discuss the most pressing issues affecting the widespread implementation of ctDNA testing services in lung cancer. Visit our project page to find out more about our work in this area.