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Lessons from a National Liquid Biopsy Program to Provide Cancer Testing and Treatment for Patients with Advanced Solid Tumors †
by
, , , and
Anna Lapuk
1,2,*
,
Benjamin L. S. Furman
2,
Pedro Feijao
1,2,
Ebru Baran
2,
Sonal Brahmbhatt
2,
Betty Chan
2,
Ka Mun Nip
2,
Adrian Kense
2,
Brenda Murphy
2,
Ruth Miller
1,2,
Vincent Funari
2,
Alicja Parker
2,
Melissa K. McConechy
2,
Shaqil Kassam
3,
Arif A. Awan
4,5,6,
Bryan Lo
6,
Daniel Breadner
7,
Barry D. Stein
8 and
David G. Huntsman
2 1
Avitia Inc., Montreal, QC H2S 3H1, Canada
2
Imagia Canexia Health, Vancouver, BC V6R1P2, Canada
3
Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, ON L3Y 2P9, Canada
4
Ottawa Hospital Research Institute, Ottawa, ON K1Y 1J8, Canada
5
Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8M5, Canada
6
Department of Anatomical Pathology, The Ottawa Hospital, Ottawa, ON K1H 7W9, Canada
7
Verspeeten Family Cancer Centre, London Health Sciences Center, London, ON N6A 5W9, Canada
8
Colorectal Cancer Canada, Montreal, QC H3Z 2P9, Canada
*
Author to whom correspondence should be addressed.
†
This work was conducted at Imagia Canexia Health, the assets of which have been acquired by Avitia Inc.
Curr. Oncol. 2026, 33(1), 18; https://doi.org/10.3390/curroncol33010018 (registering DOI)
Submission received: 1 November 2025
/
Revised: 3 December 2025
/
Accepted: 24 December 2025
/
Published: 29 December 2025
(This article belongs to the Section Oncology Biomarkers)
Simple Summary
Detection of the patient-specific mutations present in an individual tumor is critical for the selection of the best treatment option for cancer patients. Liquid biopsy (LBx) allows the detection of such mutations in a less invasive manner and is often faster than traditional tissue biopsy. Here we report a successful experience of running an LBx program for Canadian patients with advanced solid tumors. The testing was done over the course of three years for >4000 patients referred from >150 institutions. A total of 97% of patients received high-quality testing results within an average 8 days, which provided oncologists with actionable information for treatment selection. This study has demonstrated the feasibility and growing demand for LBx testing in Canada with the potential to improve patient outcomes, while allowing the healthcare system to operate more efficiently.
Abstract
Personalized cancer treatment depends on the accurate and timely detection of the patient tumor variants. LBx enables minimally invasive tumor mutation profiling. We report results of a pan-Canadian LBx program for patients with advanced solid tumors. Plasma samples were tested at Imagia Canexia Health accredited laboratory using the clinically validated Follow It 38-gene panel. A proprietary platform was used to identify clinically relevant variants in the circulating tumor DNA and report results following accepted international guidelines on clinical significance. A total of 4229 eligible patients submitted samples for LBx testing, and reports for 97% of them were delivered within ~8 days. More than 80% of Canadian oncologists from >150 institutions across 12 provinces (11% from rural centers) participated in the project. The patient cohort consisted mostly of advanced or metastatic lung, breast, and colon cancers. ctDNA mutations were detected in >50% of cases, and clinical trials were recommended for 76% of all participants. Health economics modeling analysis found that Follow It® in combination with tissue biopsy was cost-saving and resulted in an additional 0.1138 QALYs gained relative to tissue biopsy alone. The successful pan-Canadian implementation of a cost-effective, robust LBx testing program demonstrated its sustained demand and feasibility, and its potential economic and health benefits.
Keywords:
liquid biopsy; NGS; biomarkers; precision oncology; health economics
