Combining three powerful tools in effort to detect cancer early

Surgeon Dan Raz, M.D., M.A.S., is City of Hope’s co-director of the Lung Cancer and Thoracic Oncology Program. He’s on a crusade to develop the most effective cancer screening and early detection tools possible and make them available to the maximum number of people, especially those with cancer in the family
There’s a certain urgency to his voice and demeanor.

The urgency comes from a personal place. The clock is ticking.

“I have a strong family history of cancer,” he explained. “It has shaped my life, and it’s the reason I went into medicine.”
Raz lost his mother, two aunts and both maternal grandparents to cancer. He grew up in a home where the disease lurked constantly. It left a mark on him.
“Mom always said she’d go early,” he lamented, then added, almost matter-of-factly, “And I have the same worry.”
It’s a terrible burden to carry, and Raz says too many people find themselves in exactly the same situation. A strong family history of cancer weighs on them, creates ever-present anxiety and uncertainty, as well as deep frustration because as yet there is no reliable test or screening of the whole body that can tell if any cancer is present.
But what if there were such a test? Would it ease people’s minds, knowing they could find out for certain, on a regular basis, yes or no?
Doctor Dan Raz

Dan Raz, M.D.

Raz aims to find out with a new study taking a “trifecta” approach, working with study co-leader Stacy Gray, M.D., chief of the Division of Clinical Cancer Genomics.

While there’s no single test capable of finding any cancer anywhere, some existing tools do come close, and they keep getting better. The study will utilize all three.
1. Liquid Biopsy:  Many believe this is the future of cancer detection. A liquid biopsy is an ultra-sophisticated blood test that can spot floating cancer cells or altered DNA indicating the presence of cancer — somewhere. Several varieties of liquid biopsies are in development, and results so far have been mixed. The new study will utilize a supersensitive liquid biopsy product that “detects over 3,000 variants of 272 cancer-related genes,” according to the protocol.
2. Whole Body Magnetic Resonance Imaging: Unlike a liquid biopsy, magnetic resonance imaging (MRI) can’t pick up a DNA alteration or a single cell. But it can pinpoint a cancer’s location — if the tumor is large enough, usually a centimeter or more. MRIs are used routinely to search for cancer in specific organs. But scanning the entire body for cancer — an expensive and time-consuming process — is not considered the standard of care, with a couple of exceptions. Patients with multiple myeloma and the rare, inherited disorder known as Li-Fraumeni syndrome do whole body MRIs because their cancers can turn up anywhere. Moreover, Li-Fraumeni syndrome patients are susceptible to radiation — it can trigger cancer growth. So for them, a whole body MRI — which uses no radiation — is preferable to a CT scan.
“We want to see if liquid biopsies and whole body MRIs can complement each other,” said Shana Landau, M.D., assistant clinical professor of diagnostic radiology at City of Hope and a co-investigator on the study. Pejman Mortarjem, M.D., assistant clinical professor in the Department of Diagnostic Radiology, is another co-investigator on the study.

Shana Landau, M.D.

One hundred people will take part. Each must have a strong family history (at least two close relatives) with cancer. Each participant will complete a survey designed to measure their anxiety and where they stand on the “cancer worry scale.” Participants will receive three baseline screenings: a DNA or “germline” assessment, to establish the presence of any anomalies, like the BRCA1 or BRCA2 mutations; the liquid biopsy; and finally, the whole-body MRI.

Six months later, everybody will fill out the survey again, to see if their anxiety levels have changed.
What will success look like?
“If people who participate find the experience positive, and this approach makes them feel more reassured,” said Raz.
Because it’s such a small study, investigators don’t expect to spot many cases of cancer in this group — perhaps one or two participants will be found to have an actual malignancy. The study team will inform each participant about his or her screening results, and if anything “concerning” turns up, especially from the whole-body MRI, patients will be pointed toward additional scans and follow-up care.
But the real goal here is to collect data and begin a longer, broader, more diverse and more detailed process.
“This is a first step,” added Raz.
Could we one day see every patient routinely getting regular liquid biopsies and whole body MRIs, similar to regular mammograms and PSA screenings?
“That would be wonderful,” said Landau. “But that’s a long way off.” What’s here now is technology that makes today’s MRI machines more powerful, with increased magnet strength and better software. “Speed and resolution have improved, increasing our chances of detecting smaller lesions,” she said.
The idea of deploying these leading-edge tools for this first-of-its kind study intrigues both Landau and Raz.
“We’re trying to create a new way to detect cancer, using the very latest technology,” explained Raz, “while also leveraging the strengths of City of Hope, so we can do this safely and effectively.”
“I’m excited to be a part of this — the possibility of creating a new standard protocol for early cancer detection,” Landau echoed. 
“I am hopeful people will benefit from this in the future.”
If you are 50 years old or older and have a strong family history of cancer you may be eligible to participate in the study. For more information, please contact the study's clinical research associate Aaron Ceniceros at [email protected] or 626-218-4685.