Application of liquid biopsy genotyping in lung cancer | LCTT
During the last decade, several tumor molecular alterations have been identified as drivers of cancer proliferation and survival, leading to the development of novel specific targeted agents for different tumors, including lung cancer. Concerning non-small cell lung cancer (NSCLC), the advent of targeted therapy with tyrosine kinase inhibitors (TKIs) improved the overall patient outcomes with a better tolerability and safety profile when compared to platinum-based chemotherapy.
Conclusions: In this article, we present a review of the currently available data about the utility and application of liquid biopsy in lung cancer, with a particular focus on the approach to different techniques of analysis for liquid biopsy and a comparison with tissue samples as well as the potential practical uses in early and advanced/metastatic NSCLC.
• Source: Lung Cancer: Targets and Therapy
• Conclusions/Relevance: “Liquid biopsy may represent a less invasive and more feasible alternative to tissue biopsy in many cancer settings, from a promising detection method for minimal residual disease (MRD) and recurrence in patients with resected disease, to a dynamic assessment of tumor mutability in advanced disease.”
• Liquid biopsy is important in both localized and metastatic disease. Detecting ctDNA and MRD is effective in the early detection of recurrence after loco-regional treatment or as a screening tool in early disease, whereas in the metastatic setting, oncogene-addicted NSCLC patients may derive the most benefit from this test.
• The authors of the review covering liquid biopsy in the setting of NSCLC wrote that in the oncogene-addicted NSCLC patient, “liquid biopsy is emerging as an integrative analysis of molecular tissue characterization and as a ‘plasma first’ approach for assessing predictive and prognostic biomarkers at the time of diagnosis and during the treatment.”
• Although the testing of ctDNA and circulating tumor cells (CTCs) in high-risk patients can pick up lung cancer early, there is no evidence-based guidance to use this approach for screening in clinical practice. Nevertheless, ctDNA profiling could help identify patients who received curative surgery for lung cancer and, therefore, are less likely to benefit from adjuvant chemotherapy.
• The authors wrote, “Since the first IASLC liquid biopsy statement, many studies have been designed to support the extension of ctDNA analysis to other recommended and treatable oncogenic drivers according to international guidelines, including MET amplification and exon 14 skipping mutations, RET rearrangements, HER2 mutations, and, lastly, exon 2 KRAS mutation. Currently, all these studies are ongoing. Enrollment of patients in clinical trials should be encouraged to further validate the methods.”