NHS launches 'revolutionary' blood test to diagnose cancer and fast-track treatment

A "revolutionary" blood test is being rolled out on the in a world-first that will see thousands of patients receive personalised treatment sooner. The new "liquid biopsy" test searches for tiny fragments of DNA that are shed by tumours into the bloodstream. It can deliver a specific diagnosis up to two weeks earlier than usual tissue biopsy methods, allowing doctors to select the right targeted therapy faster and sparing patients unnecessary tests and treatment.

Announcing the rollout on the eve of the world's largest cancer conference, which will take place in Chicago from Friday, NHS national clinical director for cancer Professor Peter Johnson hailed a "new era of personalised cancer care". Liquid biopsies could eventually be harnessed to "scan the body" and spot developing cancer with a single blood sample, he added.

Prof Johnson said: "It's fantastic that we are now able to expand the use of this revolutionary test on the NHS to help tailor treatment for thousands of patients across the country.

"Cutting-edge genomic testing is helping us deliver more targeted and kinder care for patients, enabling some to avoid more intensive treatments such as further chemotherapy, which can have a huge impact."

After successful pilots, the test will be rolled out to all hospitals in England for up to 15,000 patients with suspected non-small cell each year.

They will be offered the test in after being referred by their GP or specialist consultant, and if a CT scan shows suspected lung cancer. Until now, tissue biopsies have been used to confirm a diagnosis and samples could then be sent for genomic testing.

The new approach will see the NHS become the first health system in the world to roll out a "blood test first" approach, with tissue biopsies following later.

Pilot studies showed that patients who received the test were fast-tracked to receive targeted therapy, tailored to the genetic profile of their tumours, around two weeks earlier.

The test will also be used for around 5,000 women with advanced , to determine if they carry one of four genetic variants which could be targeted with life-extending treatments after previous ones failed.

Hospitals have started implementing it, benefitting around 1,600 patients with suspected lung cancer and 600 with breast cancer since April. And the NHS is looking at expanding the blood test to other types including and gallbladder cancer.

Prof Johnson added: "We are already seeing the difference this test can make in lung and breast cancer - and we hope to roll it out for patients with other forms of cancer in the near future.

"As research progresses, it's exciting that this approach has the potential to help us 'scan' the body in a single blood test to see where and how cancer may be developing and target it with speed and precision to help save more lives."

During a pilot phase, around 10,000 sufferers with non-small cell lung cancer received the liquid biopsy at 176 hospitals.

An independent health economic assessment estimated the test could save up to £11 million per year in lung cancer care through reducing unnecessary diagnostic procedures and treatment, including chemotherapy.

Professor Sanjay Popat, consultant medical oncologist at The Royal Marsden and clinical-co-lead of the pilot, said: "We have seen first-hand how the implementation of a simple blood-draw and testing in our laboratory has revolutionised treatment for lung cancer patients.

"Earlier access to highly effective targeted medicines allows more patients to avoid delays, start treatment early, and start the best treatment for their type of cancer. I am really pleased that we are now able to roll this out nationally."

Co-lead Professor Alastair Greystoke, an honorary medical oncologist at the Newcastle upon Tyne Hospitals NHS Foundation Trust, said: "This is the first ever national implementation of a 'liquid biopsy first' approach to the diagnosis and treatment of a cancer.

"Not only has it led to faster and more precise treatment for patients with lung cancer, but we have also been able to show that this is a cost-effective measure for the NHS and set up the framework to evaluate this in other cancers going forward."

Professor Dame Sue Hill, Chief Scientific Officer for England, said the announcement marked "a real step-change in care for eligible lung and breast cancer patients on the NHS".

She added: "The liquid biopsy testing enables genomic mutations in the fragments of cancer that enter the bloodstream of these patients to be detected.

"This testing is transforming care and helping clinicians match patients earlier especially when cancer tissue may not be available with potentially life-extending targeted therapies rapidly and with greater precision.

"This test is a great example of the NHS harnessing the power of genomic technological advances to enable the latest groundbreaking treatment to be delivered to patients."

Separate research into the use of liquid biopsies to diagnose and monitor cancer is due to be presented at the American Society for Clinical Oncology's annual conference this weekend.

Dr Julie Gralow, ASCO's chief medical officer and executive vice president, said the tests were "a cool way of not having to stick needles into wherever the cancer is, but just drawing blood".

She added: "If you had three spots in the liver, five spots in the bone and a spot in the lung, it might be that 90 per cent of them are still responding to treatment but one is growing.

"You can't go and stick a needle in all of them but, if you look in the blood, the most active cancer - the one that's growing - is the one that's shedding its DNA and that's what you're going to find in the blood. It helps you hone in on the active part of the cancer."

Dr Gralow said cancer blood tests could also allow doctors to better detect when, and understand how, tumours are becoming resistant to treatment.

She said: "You can see this mutation happening and intervene before you see obvious evidence of the tumour growing or spreading to new places.

"It's live monitoring at a level that is actually much more specific and early than waiting for it to show up on scans."

Dr Isaac Garcia-Murillas, a staff scientist in the Molecular Oncology Group at The Institute of Cancer Research, London, said the potential benefits for patients and cost savings for the NHS were "incredible".

Some tests could allow cancer that has spread with "micro metastases" to be spotted up to a year before they would be visible on scans, he said.

He added: "Not only is the whole imaging pathway cumbersome, but by the time you have tested a tumour by imaging it has already grown.

"If you pick it up earlier you can intervene earlier and smaller tumours might respond better to drugs, so you are not only making it easier, you can improve patients' outcomes."

Such blood tests cannot yet replace the need for tissue biopsies, Dr Garcia-Murillas said, but their potential is "unstoppable now and there is a sense of urgency in the cancer community".

He added: "I think we are at a stage where something we have researched for years will become the standard of care for most solid tumour types and that is super cool."

'The test identified my cancer - now drugs are shrinking it'

Mum-of-four Rebeca Proctor was diagnosed with stage four non-small cell lung cancer in January after having the blood test.

It showed her cancer had an ALK genetic mutation, and as a result she was given the targeted treatment brigatinib. A tissue biopsy then confirmed the mutation around 10 days after her liquid biopsy results.

Rebeca, 41, said: "When I found out I had stage four cancer it felt like I'd been punched in the gut.

"I was scared, I just thought about my children, and if I would get to see my little girl start nursery, and how I would explain my diagnosis to my children - it was just heart-breaking to think about.

"But the medication has given me my life back and my kids have got their mum back."

Rebeca, from Carlisle, had been treated for a suspected chest infection a few months earlier, with symptoms including breathlessness, pain in her right shoulder, fatigue and coughing blood.

She added: "I'm taking it day-by-day and for now the treatment is doing what it's meant to be doing and shrinking the tumour, and I've got my energy back.

"I know I'm not going to be cured but I've come to terms with my diagnosis and the pills are stopping my cancer cells from spreading. We'll keep fighting this and dealing with what's been thrown at us."