RNA Liquid Biopsy for Early Cancer Detection and Treatment Guidance
Featuring: Alex Rolland, BSc in Molecular/Cell Biology
In short
Alex Rolland, Chief Research Director at Cancer Treatment Options and Management, explains how liquid biopsy tests that analyze RNA from cancer-released exosomes can detect cancer activity before a visible tumor appears, track real-time treatment response, and identify the molecular drivers actively fueling a patient's cancer. The resource covers how this approach differs from standard DNA-based liquid biopsies, who the test suits best, and how to access it — helpful for patients seeking earlier or more precise diagnostic information alongside their conventional care.
- •Standard imaging (CT, MRI, ultrasound) can only reliably spot tumors larger than 0.8 cm — ask your care team whether an exosome-based RNA liquid biopsy could give earlier or additional information in your situation.
- •If you are on immunotherapy and your scans show a growing tumor, ask about 'pseudo-progression' — an exosome liquid biopsy may help clarify whether immune cells are actually attacking the tumor rather than the cancer spreading.
- •The exosome RNA test costs about $1,500 and can be ordered directly without a doctor's referral through Liquid Biopsy Labs or Cancer Treatment Options and Management, which also offers patient navigators to help you interpret results and discuss them with your oncologist.
- •Exosomes are typically released in high numbers only when cancer is metastatic or active — so this test is most informative for patients with active or advanced disease, not those in remission.
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Brad Power October 16, 2024 “You may have heard about the exciting new world of exosomes. Exosomes are membrane- bound vesicles (small sacs filled with fluid). They're excreted by cells, and all cells use them to communicate. More importantly, they're used by cancer cells. ” – Alex Rolland “It's really important to use as many different tests as possible. Education is power. Knowledge is power.
The more different platforms we have to look at, the better.
Meeting Summary
Time pressures and money constraints can cause you and your medical team to miss out on the latest advancements in new, effective diagnostic tests. For example, the use of RNA testing is increasingly being considered as a useful diagnostic test (beyond scans and DNA testing). 8 cm. Sometimes these scans find areas that seem "suspicious" or "high risk," but they can’t tell for sure if they are cancer tumors.
In these cases, doctors often use a “watch and wait” approach, tracking whether the area grows. But focusing only on the size and density of the tumor can mean missing early chances to detect and treat cancer. Alex Rolland, Chief Research Director and co-founder of Cancer Treatment Options and Management is uniquely qualified to talk about a new test that offers additional capabilities: RNA testing using liquid biopsies.
He is passionate about ensuring that anyone who receives a cancer diagnosis has access to the most effective and least invasive forms of testing and treatment possible. Alex holds a BSc in Molecular/Cell Biology from the University of Victoria, and studied Medical Genetics at the Terry Fox Laboratory in Vancouver (BC Cancer Agency).
With over a decade of experience researching, consulting, and advocating for cancer patients, Alex also works directly with the medical system to explore the newest optimal treatments for his clients. He’s an expert in discovering how to optimize your cancer treatment, and making this a reality for you. Why might you want to learn about liquid biopsies that look at RNA in exosomes?
Ideally cancer can be detected early, before it forms a visible tumor. Liquid biopsy (blood or other liquid) tests that look at tumor exosomes (small, membrane-bound sacs filled with fluid) can find cancer activity early, leading to faster detection and better treatment outcomes. An exosome is a tiny bubble-like structure that cells release. These bubbles carry various molecules, such as proteins, DNA, and RNA, from one cell to another.
Exosomes play an important role in cell communication and can be found in body fluids like blood, urine, and saliva. Scientists can use exosomes to study what's happening inside the body without needing a traditional tissue biopsy. Exosomes are produced by the cancer cell as soon as it is transformed. The process of metastasis starts well before a tumor is even detectable.
By the time a tumor is 1 cm, it has a billion cells, and there are tumor cells all over the body. When cancers are detected at an early stage, you have fewer different kinds of cancer cells (“heterogeneity”), and they will not have spread as widely throughout your body. Your test should also ideally identify your specific molecular drivers in real time and understand how your genes are being turned on and off (“epigenetic regulation”).
What are the benefits of exosome-based liquid biopsies?
•Detect if there is cancer activity happening before there's a visible tumor.
•Detect if you are responding to therapy in real time.
•Determine what RNA molecules are highly overexpressed that are involved in driving the cancer at that given moment (possibly pointing to a targeted therapy).
•Determine drug response very quickly – by seeing if there are a lot of exosomes or not.
•Detect “pseudo-progression” – if you are on an immunotherapy, the immune cells can enter your tumor and make your tumor look bigger, but they're actually eating them from the inside out. It’s hard to detect with imaging, but there will be a low amount of exosomes in the body if you are responding to immunotherapy.
•Detect emerging treatment resistance over expressed oncogenes for targeted therapies. How does this liquid biopsy exosome test differ from other liquid biopsy tests? Most liquid biopsy tests use circulating tumor DNA. They are designed for detecting emerging DNA mutations. They're not designed for detecting the level of the actual mutation in the blood, because they are not looking at the exosomes. The exosomes are a cancer-specific mechanism, and by isolating the exosomes, you're looking at exactly what the cancer is doing, and you're getting the relative amount of that mutation in the blood. Some other companies are looking at genes expressed through RNA. Some of them are doing it from exosomes. But the problem is the panel that they're using is designed for detecting mutations, and it's not accurate for detecting expression. RNA gets degraded significantly once you take it out of the body. Therefore, you can't always tell what was actually produced by the tumor there if you're not looking specifically at the exosomes and looking at a gene panel or an expression panel designed specifically for expression. Is this exosome test a good fit for you? Exosomes are only typically released in high numbers if your cancer is metastatic. If you are responding to therapy, or are in remission, you won't see a lot of these exosomes. How can you get these exosome tests? You can order this test yourself. (You don't need a doctor to order this for you.) The cost is about $1500. There are a couple of websites for access:
•The Cancer Treatment Options and Management site offers a research and analysis team and a patient navigation program. It includes experts like Alex who analyze the test data and make sure it's utilized to your best advantage. There are navigators who help with access. They coach you on the language to use with your oncologist to get better uptake, and on the back end with all the programs and the paperwork.
•At Liquid Biopsy Labs you can order the specific test, if you don’t want the other services. How can you learn more about RNA testing and other key elements of personalized treatment?
•Book a one-on-one cancer care consultation on testing and treatment options
•Join the free precision cancer medicine education and advocacy program : “Cancer – Just The Facts” with video lessons, downloadable .pdfs and live question and answer video sessions
•Join the Facebook community Cancer Treatment Options and Management
•Visit Alex’s YouTube channel, “The Cancer Guy” ; subscribe to stay informed (new videos every week)
•Review sample reports of the liquid biopsy test
•Review formal research on the liquid biopsy test once the commercialization process is complete
•Contact Alex at contact@ctoam.com The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. Meeting Notes KEYWORDS liquid RNA, cancer diagnosis, exosomes detection, precision oncology, tumor suppressors, oncogenes, epigenetic regulation, molecular drivers, pseudoprogression, hyper progression, liquid biopsies, RNA expression, tumor cells, pathology reports, direct-to-consumer SPEAKERS Alex Rolland (63%), Brad Power (18%), Michelle Morand (15%), Brian McCloskey (4%) CHAT Allen Morris, Stratis Telloglou, Roger Royse, Ari Akerstein, Rick Davis, Ryan Ramanujam, Jane Wilkinson, Brian McCloskey, Chris Apfel, Eric Dishman SUMMARY Alex Rolland discussed the potential of liquid RNA as a diagnostic tool for cancer, emphasizing its role in detecting early-stage cancer and real-time molecular drivers. He explained the mechanisms of “oncogenes”, “tumor suppressors”, and “transcribed RNA”, and highlighted the benefits of exosome-based liquid biopsies, including rapid drug response detection and identifying pseudo-progression. He noted the limitations of current tests, such as circulating tumor DNA (ctDNA) and RNA panels, which often lack specificity and accuracy. He also discussed the importance of pathology and the use of laser capture microdissection to isolate tumor cells for precise analysis. The test costs $1,500 and is available directly to consumers. OUTLINE Introductions
•Alex Rolland was recommended to the Cancer Patient Lab by Roger Royse, who found Alex's advice helpful in his cancer journey.
•Alex introduced his partner, Michelle Morand, who is the operational leader in their company, Cancer Treatment Options and Management. Cancer Basics and Personalizing Cancer Care
•Alex introduced the basic mechanisms of cancer and the importance of targeting these mechanisms in personalized cancer care.
•“Oncogenes” (a mutated gene that can cause cancer by causing cells to grow and divide uncontrollably), “tumor suppressors” (also known as anti-oncogenes, genes that regulate cell growth and division to prevent cancer; when they are mutated, they can no longer control cell growth, which can lead to cancer.), and “transcribed RNA” (or the RNA transcript, the RNA strand produced when a gene is copied from DNA into RNA) have roles in cancer development.
•There are many challenges in cancer detection, including late-stage detection and identifying molecular drivers in real-time.
•“Epigenetics” describes how genes turn on and off to create different cell types. Environmental and behavioral factors can impact how genes function without changing the DNA sequence. Epigenetic changes can be reversible and can be passed on from one generation to the next.
•Epigenetic changes can lead to cancer and the potential of detecting cancer at an early stage through epigenetic analysis.
•Ideally cancer can be detected before it forms a visible tumor. Exosomes and Liquid Biopsies
•Exosomes are small, membrane-bound sacs with fluids (vesicles) that are released from cells and carry proteins, lipids, nucleic acids, and metabolites.
•Exosomes have a role in cancer cell communication and the spread of cancer.
•Exosomes can convert normal cells into tumor cells.
•Exosomes offer the potential to detect real-time molecular drivers in cancer.
•The benefits of exosome-based liquid biopsies include determining drug response quickly and detecting pseudoprogression in immunotherapy.
•Exosomes can be isolated from blood and analyze the RNA inside for diagnostic purposes. Development and Validation of the Test
•Their panel was developed in collaboration with Norgen Biotek to isolate cancer-specific exosomes from blood.
•The process of isolating RNA from these exosomes and analyzing it uses a panel of nearly 21,000 genes.
•A healthy tissue database was created for comparison and the use of statistics (Stat-1 and Stat-2) to assess RNA expression.
•The diagnostic and predictive capabilities of the test uniquely enable detecting cancer activity before a visible tumor and real-time response to therapy. Challenges and Limitations
•Exosome-based liquid biopsies have limitations, such as the need for high exosome numbers in metastatic patients.
•Verifying cancer activity before a visible tumor is difficult; test results must be compared with clinical data to validate the test.
•There is an ongoing collaboration with an AI group to detect specific signals and identify unique molecular features of certain cancers.
•An example was a test run with breast cancer, demonstrating the test's ability to differentiate between breast and lung cancer. Q&A: Diagnostic Challenges and Market Positioning
•Brad Power asked about the challenges of getting a diagnostic tool to market and the regulatory pathway in Canada.
•Alex and Michelle Morand explained their approach of heavily stratifying patients and using extensive tumor DNA sequencing and RNA expression testing.
•They discussed the importance of working with public healthcare oncologists and using a CLIA CAP-approved lab in the US for validation and commercialization.
•Alex and Michelle emphasized the unique aspects of their test, including the use of exosomes and a specialized RNA expression panel. Q&A: Prostate Cancer and Interpreting Results
•Brian McCloskey asks about the sensitivity threshold for prostate cancer and the interpretation of results into treatment options.
•Alex explained the limitations of PSA monitoring and the importance of using CtDNA and PSMA from PET scans.
•He discussed the test's ability to detect neuroendocrine differentiation in prostate cancer and the importance of using multiple approaches for diagnosis.
•Alex and Michelle highlighted the test's role in validating tumor DNA sequencing results and providing actionabl actionable insights for treatment. Q&A: Business Model and Scaling
•Brad Power and participants in the chat asked about the business model, reimbursement pathway, and scaling the test.
•Michelle Morand outlined the four steps for scaling the test: equipment, training, analysis, and delivery of results.
•She emphasized the importance of direct-to-consumer tests and the preparation for scaling, including a partner lab in Orlando.
•Alex and Michelle discussed the distinction between thorough RNA testing and fusion gene testing, highlighting the unique aspects of their test. Q&A: Pathologist Collaboration and Final Thoughts
•Brad Power asked about the collaboration with pathologists and the process of working with biopsy samples.
•Alex explained the use of laser dissection to isolate tumor cells and the importance of working with highly purified samples.
•Michelle Morand adds that their lab uses a 550-gene DNA panel and a 21,000 RNA panel, with samples sent to a specialty pathology lab for laser dissection.
•Alex and Michelle provided final thoughts on the importance of accurate RNA testing and the potential for future publications and commercialization.
Full transcript
Brad Power This is the Cancer Patient Lab. We are honored to have Alex Rolland with us. He’s beaming to us from a hotel somewhere in British Columbia. He's going to talk to us today about liquid RNA and some of the things he's been seeing and its use as a potential diagnostic tool for us. This is for information purposes only. This is not medical advice.
We try to arm our patients and caregivers with information they can take to their medical team, giving them ideas that might help in navigating their care. org, and finding the donate button. Roger Royce introduced us, even though maybe Alex doesn't remember him. Roger, early in his journey, was looking for resources to help him, and found Alex and got some advice from him and recommended that we learn from Alex today.
Alex Rolland
Thank you very much for having me today. I'm very excited to share some of our latest data and latest research. Today I'm going to talk about using liquid RNA. “Liquid” means blood, but really, “liquid” can be any sort of fluid. This is my partner, Noushin Moshgabadi, on the bottom right.
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