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When is liquid biopsy preferred for Comprehensive Genomic Profiling?

The change and development in liquid biopsies is progressing at a dizzying pace. The future will be built on liquid biopsies. Although there are very serious developments today, in cases where tissue biopsy cannot be obtained from the patient, the opinion that liquid biopsy should be performed is dominant. However, if the patient's tumor burden is low, in other words, if the number of metastasis is low and the tumor size is small, liquid biopsies are generally unsuccessful in these cases. However, if the patient's tumor is large and has many metastases, liquid biopsies are almost as effective as tissue biopsies in these patients. Therefore, if liquid biopsy is to be preferred or if tissue biopsy is problematic, a comprehensive genomic profiling test should be decided by obtaining a 2nd opinion from an experienced center. In liquid biopsies, there may be insufficient DNA acquisition and incomplete results.

How are comprehensive genomic profiling tests performed?

Comprehensive genomic profiling tests can be performed by analyzing cancerous tissue or by separating and analyzing tumor DNA fragments from blood.

Analyzes made from cancerous tissue are more prominent currently. However, soon, it will be made from blood to a large extent.

First, analysis should be preferred by performing a biopsy from the tumor tissue. If the patient has received many treatments and there is no response, a re-biopsy is performed, and the genomic analysis of the latest tumor is the most accurate method. Genomic profiling obtained from the tissue of a patient who had surgery 2 years ago and received many treatments 2 years ago may give incomplete or erroneous information. Because differences in mutations can develop over time. Comprehensive genomic profiling with biopsy from the most recent tumor is the most accurate way.

Which patients should have comprehensive genomic profiling tests?

Cancer patients at any stage may want to obtain this information. In other words, a person who has cancer has the right to learn about the biology of cancer. However, as a highly experienced physician, I recommend it to my patients in stages 3 and 4. That is, in situations where I can change the treatment or determine it according to this test. However, sometimes my patients can request it at an early stage, and we can provide this service to them as well. However, the role of comprehensive genomic profiling tests in determining treatment in early-stage cancers is less than in advanced stages.

With these tests, is it possible to recommend drugs that the insurance system does not pay for?

It is the change in cancer biology that determines the treatment in personalized cancer treatment based on comprehensive genomic profiling and how to make interventions for it. We, who design personalized cancer treatment, focus on points such as how we can touch the life of our patients and how we can achieve better results while designing the treatment. Being able to design the treatment is the greatest happiness. After that, it is necessary to think about insurance systems. Today's reimbursement systems are not yet tailored to personalized cancer treatments. However, positive answers can be obtained when applying to reimbursement institutions after the scientific rationale and evidence are presented.

It is important to determine the treatment first.

Should I get a 2nd opinion for my Comprehensive Genomic Profiling Test?

It should definitely be taken. Getting a second opinion is very helpful in any situation. It is valid for surgery, for cancer treatment and for many conditions of health problems. As a result of comprehensive genomic profiling tests, you can get a curation report both from abroad and from the Medicana personalized cancer treatment center. Even our doctor can get a second opinion from private platforms.

How should comprehensive genomic profiling testing be evaluated?

Comprehensive genomic profiling tests do not to offer you a direct treatment. These tests give you mutations, changing molecular structures, and changing biology. It is the job of the molecular tumor board to analyze them and design a treatment. Therefore one cannot say that the test gave no information for a targeted therapy. By learning the biology of the tumor, it is important to determine what to do and what not to do.

For this reason, it is best to request a curation report from your doctor for your test results.

Is comprehensive genomic profiling testing performed in our country?

Comprehensive genomic mapping is done in limited numbers in our country, but I think that their number will increase in the near future. However, such a test within the scope of reimbursement institutions is not yet available in our country.

In many universities and public hospitals, tests with narrower panels are performed.

Test prices are very different, which test should I have?

You are so right about this. Essentially, it is the approval of the test and the genomic analysis technique that determine the price of the test. In other words, the prices of tests that perform comprehensive genomic analysis are above a certain level. There is no significant difference between these tests. The important thing is the evaluation of these tests. The personalized cancer treatment experience at your center is important. Basically, choosing the test recommended by your doctor will be the most cost-effective way. However, if you have done comprehensive genomic profiling at your own request, it would be best to apply to a center experienced in this field and request a curation report as a result

Which test should I have?

Essentially it depends on your purpose. If there is a molecular tumor board in the center where you are treated and if your results will be evaluated by an experienced team, the best decision would be comprehensive genomic profiling. In other words, comprehensive genomic profiling tests are scientifically proven to be accurate, and every spot of more than 300 genes is analyzed.

However, if these facilities are not available, or at the discretion of you or your physician, treatment decisions can be made with narrower tests. Mutations detected by these tests are also important in personalized treatment. However, if mutations cannot be detected with these tests, this does not mean that you are not suitable for personalized treatment. It is not true to say that there is no gene detected and I am not suitable for this approach. It means that there is no mutation in the analyzed gene regions. Cancer does not develop without mutation, there must have been a difference that cancer developed. In this case, comprehensive genomic analyzes should be performed.

In addition, price differences between these tests and whether they are within the scope of reimbursement institutions also show differences.

How is personalized cancer treatment organized?

First of all, it is necessary to reveal the genetic information that has been altered in your cancer. Therefore, "Comprehensive Genomic Profiling" should be done. Here, it is necessary to evaluate all the information-producing, protein-coding points of approximately 300-600 genes. That is, sequencing of the entire exon should be done, not analysis of targeted regions. Once this sequencing is done, it should be evaluated by an approved and accepted bioinformatics. As you can understand, it is difficult to understand and interpret the detailed technical data here. For this reason, if personalized treatment is to be performed in cancer, I recommend you have your test done after getting opinions from at least 2 places experienced in this field.

The purpose of these tests is not a direct treatment recommendation. It is the arrangement of patient-specific treatment by learning the biology of the deteriorated mechanisms in cancer. For this reason, cancer biologists work in personalized cancer treatment centers.

What is personalized cancer treatment?


Genes constitute a collection of information that decides how the cells in our body will grow, develop, and perform their functions. Alterations in this information determine the biology of cancers. In cancer, this information has been corrupted. Learning the biology of tumor tissue by revealing erroneous information and arranging treatment according to impaired cancer biology is called "Precision Medicine".

Personalized and precisely designed cancer treatments may cause fewer side effects than conventional chemotherapies. The reason for this is thought to be tumor-specific treatment regulation. Because personalized cancer treatments are designed for more tumors, they may affect normal cells less.

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