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The Royal Marsden and Guardant


Liquid biopsy for faster diagnosis in advanced pancreatic and biliary tract cancers in the NHS

Name and role of Project Lead

Dr Naureen Starling, Consultant Medical Oncologist & Clinical Lead, The Royal Marsden NHS
Foundation Trust

Twitter: @royalmarsdenNHS

Clinical problem

Cancers of the pancreas and bile duct have the worst outcomes of any cancer and yet the time taken to
diagnose them is longer than for most cancers. Faster diagnosis is critical to improving outcomes in these patients. Because of their location deep within the body, the NHS relies on invasive investigations such as endoscopy. One in four patients do not get a diagnosis from the first test and need repeated tests. Complications including bleeding, pain and infection occur. One in four patients also have health
conditions or frailty that make these tests riskier. These factors significantly delay cancer diagnosis.

Proposed Solution

Guardant360® is an approved blood test or ‘liquid biopsy’ by Guardant Health that uses established
technology to find tiny amounts of cancer in the blood and could revolutionise cancer diagnosis. It also
provides genomic information that can identify patients for targeted drug treatments. Incorporating this non-invasive ‘liquid biopsy’ into the diagnostic pathway could improve outcomes for patients through faster diagnosis and access to treatment. It can have the additional benefit of reducing the number of repeated invasive diagnostic procedures needed to establish a diagnosis, avoiding potential procedure-related complications, delays and saving valuable NHS resources.

Market traction & Implementation

Brought the first FDA-approved liquid biopsy to market (2020).

• Successfully partnered with the Royal Marsden to bring the technology to the UK (live April 2023).

• Liquid biopsy (LB) test used in the study SAFIR ABC010, led by UCL PI (advanced biliary tract).

• Awarded a place on NHS England's ctDNA transformation pilot to help speed up and improve Lung
cancer diagnosis in the image-suspected setting.

• Currently running the largest de-escalation study in colorectal cancer minimal residual disease to help
spare patients in the UK unnecessary chemotherapy post-surgery.

• Published over 420 high-impact factor peer-reviewed publications across multiple tumour types.
• Over 250 publications and orals out of the UK in advanced Non-Small Cell Lung Cancer, Biliary Tract
Cancer and Cancer of Unknown Primary.

• Our solution is currently implemented at RM Partners, West London Cancer Alliance, The Royal Marsden NHS Foundation Trust, Epsom and St Helier Hospitals, Croydon University Hospital, Kingston Hospital, Chelsea and Westminster Hospital, and West Middlesex Hospital.


75% of patients in the ACCESS project reported as very satisfied or satisfied with the Guardant360® liquid biopsy blood test.

Stakeholder quote

"Cholangiocarcinoma (CCA; bile duct cancer) can be very difficult to accurately diagnose. One of the reasons for this is the problem of obtaining tissue samples. Liquid biopsy offers significant potential
as an alternative to tissue biopsy, and the ACCESS study represents a promising initiative that could potentially streamline the diagnostic process and so enable CCA patients to access the treatments they need in a far more timely manner."

Helen Moremont, CEO of AMMF, The Cholangiocarcinoma Charity

Patient and Public Involvement quote

"Early diagnosis is so important for us all to beat this devastating disease and this liquid biopsy is able to do this with the added benefits of being safe and offering personalised treatment."

Jackie Edgeller, ACCESS Steering Group PPI member

Patient quote

""[The ACCESS Programme] was very important to me. I could see my initial diagnosis and it was incorrect and the liquid biopsy gave me hope. Amazing experience.""

Patient from Patient Satisfaction Survey

Date Published

September 2023


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