Patient Stories

Clinical History 
Female patient with a 19-year history of Breast Cancer and NSCLC Stage 1a diagnosed 5 years prior presented in January 2014 with PET confirmed left jugular lymph node enlargement and a RUL nodule. Fine needle aspiration confirmed metastatic NSCLC, but the tissue material was insufficient for biomarker testing. Patient received three cycles of Carboplatinum + Taxol® (paclitaxel) while undergoing concurrent CyberKnife therapy to the left neck and supraclavicular lymph nodes concluding in May 2014. Follow-up PET scan showed improved supraclavicular lymph node and stable RUL nodule. At that time, the treating physician tested the patient to predict the therapeutic benefit of using an EGFR TKI. Based on these test results, the patient was started on Tarceva® (erlotinib), an EGFR TKI therapy, which was subsequently discontinued as the patient did not tolerate the drug due to mucositis.

On November 17, 2014, NSCLC disease progression in the RUL was confirmed to be adenocarcinoma by CT guided needle biopsy. Biomarker testing was ordered, but the biopsy tissue material was insufficient.

Liquid Biopsy In Addition To Tissue 
The patient’s physician was familiar with ordering liquid biopsy testing from Biocept. Blood was drawn from the patient on November 21, 2014 and EGFR and ALK biomarker tests were ordered. Biocept’s liquid biopsy detected an ALK translocation in the blood and the results were reported to the patient’s physician on December 1, 2014.

Biocept’s Liquid Biopsy Enables Selection of Targeted Therapy – The “Gift of Time” 
Physician referred the patient for evaluation to participate in an immunotherapy clinical trial. However, it was determined that the best course of therapy was to proceed with an ALK-targeted therapy. As a result, the patient was treated with Xalkori® (crizotinib), from December 2014 – July 2016.

The identification of a clinically actionable biomarker and subsequent targeted therapy resulted in 18 months of progression-free survival (PFS) for the patient. In June 2016, the patient progressed with brain lesions, a new 3×1 cm lesion in the thyroid, mediastinal lymphadenopathy, and multiple RLL nodules. Patient was referred for stereotactic RT for the two brain lesions, (each receiving 2100 cGy dose in 1 fraction).

The patient was re-tested with Biocept’s liquid biopsy tests for EGFR, ALK and ROS1. The absence of clinically actionable biomarkers facilitated selection of immunotherapy over the alternative of a second-line ALK inhibitor. The patient was started on Opdivo® (nivolumab) in July 2016, and as of this publication has stable disease with limited toxicities.