Liquid Biopsy May Improve Outcomes in Patients with NSCLC

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Liquid biopsy is a minimally invasive procedure that can detect microscopic cancer tissue levels before, during, and after treatment.1 It measures tumor-derived markers in body fluids, including blood, ascites, cerebrospinal fluid, and urine.1 As such, it is an important tool in diagnosing and guiding treatment and monitoring response to treatment.1 The components that can be detected or measured in liquid biopsy include circulating tumor cells, extracellular vesicles, glycoproteins, cell-free DNA, and circulating tumor DNA (ctDNA).1 In advanced non–small-cell lung cancer (NSCLC), molecular profiling is important for treatment decisions, but difficulties arise if insufficient tumor samples are obtained or if wait times for testing, biopsy, or pathology assessment are long.

To determine if plasma molecular testing is feasible at the initial diagnostic workup for patients with advanced NSCLC, 60 patients with suspected advanced NSCLC were recruited to use next-generation sequencing (NGS) assays. Patient median age was 70 years, 48% had never smoked, 52% were women, and 57% were Caucasian. NSCLC was diagnosed in 73% of patients, and 12% had small-cell lung cancer. Tissue biopsy was declined by 5% of the patients. The patients who had radiologic evidence of advanced lung cancer were referred to the lung rapid diagnostic program where NGS assays that target 37 genes were performed. Standard comprehensive NGS assays on tissue samples were also performed. Actionable alterations were found in 23 of the patients with stage IV NSCLC, and 18 of these patients started targeted therapy. In 10 of these 18 patients, targeted therapy was initiated based on the plasma results prior to the availability of tissue results.

Among the 44 patients with NSCLC, 5 patients had early-stage disease. Most stage IV patients had systemic treatment with a median time to treatment initiation of 34 days, whereas the historical cohort had a median time to treatment initiation of 62 days. The median turnaround time for blood draw results was 7 days (range, 4-14 days). The median turnaround time for tissue molecular testing was 26 days (range, 11-42 days). When concordance was investigated, it was found to be 70% between plasma and tissue testing. In 3 patients, liquid biopsy identified actionable alterations not identified with tissue NGS. In 4 patients, liquid biopsy failed to identify actionable alterations found via tissue testing due to undetectable plasma ctDNA.


  1. Adashek JJ, Janku F, Kurzrock R. Signed in blood: circulating tumor DNA in cancer diagnosis, treatment and screening. Cancers (Basel). 2021;13(14):3600.

Source: Pardo MG, Czarnecka K, Law JH, et al. Plasma first: accelerating lung cancer diagnosis through liquid biopsy. J Clin Oncol. 2022;40(16 suppl):3039-3039.

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