Precision oncology, personalized medicine, and liquid biopsy
Cancer is not a single disease. Even when two people have the same tumor, their DNA, their history, and their life goals are different . Until a few years ago, most treatments were chosen based solely on the organ: breast, lung, colon… Today we can go much further.
At Nexus Oncology, we bring personalized medicine and precision oncology closer to patients, using advanced genomic platforms, liquid biopsy, and minimal residual disease studies to make more informed decisions every step of the way.
Personalized medicine: Choosing the treatment you really need
Precision oncology in advanced and metastatic disease
In advanced or metastatic disease, precision oncology plays a central role. This involves studies that analyze hundreds of genes in a single test , searching for alterations that could be targets for specific therapies or inclusion criteria in clinical trials.
Prediction of response to immunotherapy
La immunoterapia ayuda a tu sistema inmunitario a reconocer y atacar las células cancerosas. No obstante, solo un porcentaje de pacientes responde de forma duradera.
Por eso evaluamos distintos biomarcadores de respuesta:
- Expresión de PD-L1, mediante inmunohistoquímica en el tumor.
- Carga mutacional tumoral (TMB): tumores con muchas mutaciones pueden generar más “señales” para el sistema inmune.
- Inestabilidad de microsatélites (MSI) y otros perfiles genómicos que se asocian a mayor sensibilidad a la inmunoterapia.
- Diferentes subpoblaciones de Linfocitos infiltrantes del tumor (TILS)
Con esta información podemos:
- Identificar a los pacientes con mayor probabilidad de respuesta.
- Proponer tratamiento de inmunoterapia, en enfermedades donde no existe una indicación.
- Evitar fármacos de inmunoterapia en contextos donde la probabilidad de beneficio es muy baja, reduciendo toxicidad y costes.
Liquid biopsy: Information about the tumor from a simple blood test
Liquid biopsy analyzes fragments of circulating tumor DNA (ctDNA) that cancer cells release into the bloodstream. From this blood sample, we can study genetic alterations in the tumor without needing to repeat an invasive biopsy.
Its main advantages:
With our liquid biopsy panels we can:
Liquid biopsy does not always replace tissue analysis, but it complements it and, in some cases, makes it possible. It helps us see the tumor as a whole, including metastases, not just the area where the initial biopsy was performed.
Minimal residual disease (MRD): Getting ahead of relapse
Even when imaging tests show that “no tumor is visible,” microscopic amounts of cancer cells may remain in the body. This is called minimal residual disease or molecular residual disease (MRD) .
Personalized tests such as those based on patient-specific ctDNA (e.g., Signatera™ technologies) allow:
- Design a unique test for your tumor from the surgical specimen, to look for genetic alterations of your tumor in the blood after surgery and during follow-up.
- Detecting a possible relapse months before it is visible on CT or MRI scans .
- Decide whether you need adjuvant treatment (such as extra chemotherapy) or if you can safely avoid it.
These studies are especially useful in tumors such as colon, rectum, breast, lung or ovary, among others, provided they are requested in the appropriate context.
Analysis to predict chemotherapy toxicity
“We also personalize safety: some genes tell us which chemotherapy and dose is safest for you.”
Not everyone metabolizes drugs the same way. Variations in genes involved in the processing of certain medications (for example, enzymes that break down certain chemotherapy drugs) can increase the risk of severe toxicity if standard doses are used.
At Nexus Oncology we have oncological pharmacogenetic tests that allow:
- Identify patients at high risk of toxicity from certain chemotherapeutic agents.
- Adjust the dose from the start or choose safer alternatives.
- To avoid hospital admissions and serious complications related to treatment.
Personalizing your treatment isn’t just about choosing the medication; it’s also about adjusting the dosage to your genetics. These studies are done only once, and the information can guide current and future treatments.
Patient stories
Behind every diagnosis is a person, a family, and a story of resilience. In this section, we share real-life cases of patients who, with the right medical care, human support, and hope, have journeyed their own path to recovery.
Our precision medicine services and platforms
At Nexus Oncology, we work with a wide range of biomarkers, genomic tests, and multigene panels used in leading international centers. It’s not about “ordering every test,” but about selecting the tools that can truly change your treatment or follow-up .
Personalized medicine: biomarkers and platforms to decide the best treatment
Your tumor has unique fingerprints: we analyze them to tailor the treatment to your profile.
In many solid tumors, we analyze specific targets such as HER2, HRD, FOLR1, or Claudin 18.2 , among others. These biomarkers help us determine if you can benefit from specific targeted therapies , each associated with particular drugs (for example, anti-HER2 treatments in breast, gastric, or lung cancer, or drugs for tumors with homologous recombination deficiency –HRD–).
In early breast and prostate cancer, we use multigene platforms that analyze the activity of several tumor genes to estimate the risk of relapse and the actual benefit of chemotherapy:
- Oncotype DX® : 21-gene test for early hormone receptor-positive, HER2-negative breast cancer; helps decide if chemotherapy provides additional benefit to hormone therapy.
- Prosigna® (PAM50) : analyzes the expression of 50 genes to classify the breast cancer subtype and estimate the 10-year recurrence risk.
- MammaPrint® : a 70-gene signature that helps differentiate between high or low genomic risk of relapse in early breast cancer and supports the decision to use or not use chemotherapy.
- EndoPredict® : gene expression test that estimates the risk of late relapse (from 5 years onwards) in hormone-dependent breast cancer.
- Prostatype® : a genetic prognostic test for prostate cancer that helps to assess whether aggressive treatment or more conservative monitoring is appropriate.
What does it mean to you?
- In some cases these tests make it possible to avoid unnecessary chemotherapy and its side effects; in others they help to decide on a more intensive treatment when the risk of relapse is high.
- They are always requested individually , when they can actually change the therapeutic strategy.
Immunotherapy response analysis (MSI, PD-L1, TMB)
To find out if immunotherapy might be especially helpful in your case, we studied:
- PD-L1 : a protein that can be expressed by the tumor and is measured by immunohistochemistry; certain levels are associated with a higher probability of response to immunotherapy in tumors such as lung, bladder and others.
- MSI (microsatellite instability) : tumors with high MSI often respond better to certain immunotherapeutic drugs.
- TMB (tumor mutational burden) : measures how many relevant mutations the tumor has; a high TMB may be associated with a better response to immunotherapy in several types of cancer.
Pharmacogenomics: studies to predict chemotherapy toxicity
Thanks to pharmacogenomics, we study how your genes influence the way you metabolize certain drugs:
- DPYD : Variations in this gene can cause a lack of the DPD enzyme, increasing the risk of severe toxicity with fluoropyrimidines (5-FU, capecitabine).
- UGT1A1 : some polymorphisms increase the risk of irinotecan toxicity (severe diarrhea, neutropenia).
- Expanded panels (such as Oncopharmagenetics 25 genes) : collect variants in multiple genes related to the metabolism of chemotherapeutic and other cancer drugs.
With this information we can adjust the dose from the start or choose safer alternatives , reducing the likelihood of serious side effects.
Precision oncology: comprehensive genomic profiling panels
A single study can analyze hundreds of genes in your tumor and connect your case with targeted therapies and clinical trials.
For patients with advanced or metastatic disease , rare tumors, or resistance to multiple treatments, we use comprehensive genomic profiling panels in tissue or blood, including:
- FoundationOne® CDx : analyzes 300+ genes in solid tumors, as well as global signatures such as TMB and MSI, and is approved as a companion test for multiple targeted therapies.
- FoundationOne® Heme : combines DNA and RNA to study alterations in hematological neoplasms and some rare solid tumors.
- Tempus xT / xR / xE : 648 gene panel in tissue (xT), whole exome and transcriptome sequencing (xE) and RNA panels (xR) that provide a very broad view of alterations and may include TMB and MSI.
- TruSight Oncology 500 and TruSight RNA Pan-Cancer : “pan-cancer” panels of 500+ DNA genes and more than 1300 RNA genes to detect relevant mutations, amplifications, and fusions in multiple tumor types.
In addition, we use panels targeted at specific tumors , for example:
- ThyroidPrint® for indeterminate thyroid nodules, which helps rule out malignancy and avoid unnecessary surgeries.
- Specific panels for gliomas and other brain tumors , where molecular classification is key to prognosis and treatment.
- Tumor of unknown origin (CUP) platforms , which use genetic profiling to guide the possible tissue of origin and the most reasonable therapeutic options.
With a single study, we can identify multiple actionable alterations and link them to approved therapies or those in clinical trials. If no useful target is found, at least we know we have thoroughly explored the “genetic map” of your tumor.
Liquid biopsy: advanced blood panels
To study circulating tumor DNA ( ctDNA ) in blood, we use different high-sensitivity liquid biopsy platforms , such as:
- FoundationOne® Liquid CDx : analyzes more than 300 genes and biomarkers such as bTMB and MSI from a blood sample.
- Tempus xF and xF+ : panels of 100–500+ genes that detect mutations, amplifications and fusions in ctDNA and are integrated with clinical databases to generate therapeutic recommendations.
- Guardant360® CDx / Guardant360 Liquid : a widely validated liquid biopsy for advanced solid tumors, studying actionable alterations and biomarkers for targeted treatments and immunotherapy.
These tests are especially useful when:
- It is not possible to repeat a tissue biopsy.
- The tumor is in multiple locations and we want a global view .
- We need to understand why a treatment has stopped working and what resistances have emerged.
Minimal residual disease detection: Signatera™
After operating on or treating the tumor, we follow genetic traces in the blood to anticipate relapse .
In certain tumors and clinical situations we use Signatera™ , a personalized ctDNA test designed from the patient’s own tumor:
- After surgery or chemotherapy, periodic blood draws are performed to detect minimal residual disease (MRD) .
If the test is negative, the probability of remaining tumor is very low; if it is positive, we can reinforce the treatment or intensify the follow-up before the relapse is visible in the imaging tests.
All these test names might sound overwhelming. The essential thing to know is that at Nexus Oncology :
- We don’t sell tests, we design customized strategies.
- Each study is indicated only when it can change a treatment decision, can provide extra safety (less toxicity), or can help us anticipate a relapse.
- We will always explain why we recommend a specific test, what information we are looking for, and how it will influence your treatment plan.
