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Molecular Genomic Assessment Using a Blood-based mRNA Signature (NETest) is Cost-effective and Predicts

Irvin M Modlin1, Mark Kidd2, Andrea Frilling3

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|June 29, 2021
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The NETest liquid biopsy accurately detects neuroendocrine tumor (NET) recurrence after surgery, outperforming Chromogranin A (CgA). This blood test predicts recurrence with 94% accuracy and reduces follow-up costs by 42%.

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Area of Science:

  • Oncology
  • Biomarkers
  • Surgical Oncology

Background:

  • Accurate detection of residual disease after neuroendocrine tumor (NET) resection is crucial for patient management.
  • Current postoperative imaging lacks sensitivity, and existing biomarkers like Chromogranin A (CgA) are ineffective for predicting recurrence.
  • A novel multigene liquid biopsy, the NETest, is being evaluated for its utility in the postsurgical setting.

Purpose of the Study:

  • To assess the correlation of the NETest with surgical resection status in patients with neuroendocrine tumors.
  • To determine the NETest's ability to predict postoperative recurrence of neuroendocrine tumors.
  • To compare the diagnostic accuracy and cost-effectiveness of the NETest against standard biomarkers and follow-up protocols.

Main Methods:

  • A multicenter study involving 103 patients undergoing NET resection (pancreas, small bowel, lung, etc.).
  • Blood samples were collected pre-surgery (D0) and on postoperative day (POD) 30 for NETest and CgA analysis.
  • Surgical resection margins (R0, R1/R2) were recorded, and standard-of-care follow-up costs were compared with a NETest-based stratification approach.

Main Results:

  • The NETest showed 100% positivity, significantly outperforming CgA (22% positive) (P < 0.0001).
  • In R0 resections, NETest levels decreased significantly (P < 0.0001), but 36% remained elevated; CgA showed no significant change.
  • An elevated POD30 NETest predicted radiological recurrence with 94% accuracy (P < 0.0001), while a normal POD30 NETest indicated no recurrence in 53 patients.

Conclusions:

  • The NETest is a highly accurate biomarker for detecting residual disease and predicting recurrence after NET surgery, surpassing CgA.
  • Postoperative NETest monitoring effectively identifies patients at high risk for recurrence, enabling tailored follow-up strategies.
  • Utilizing the NETest for postoperative stratification resulted in a 42% cost saving compared to standard follow-up methods.