Thoracic Oncology Program, Memorial Cancer Institute/Florida Atlantic University, Pembroke Pines, FL.
Memorial Cancer Institute, Pembroke Pines, FL.
Clin Lung Cancer. 2023 Mar;24(2):120-129. doi: 10.1016/j.cllc.2022.11.007. Epub 2022 Nov 25.
In the last decade, non-small-cell lung cancer (NSCLC) treatment has improved with the approval of multiple therapies to target specific genetic alterations. Though, next generation sequencing (NGS) has traditionally been conducted from tissue biopsy samples, developing data supports the use of plasma-based circulating tumor DNA (ctDNA), also known as "liquid biopsy," to complement tissue biopsy approaches in guiding front-line therapy. This study is a retrospective analysis of 170 new NSCLC patients treated at 2 cancer centers within a 5-year period who received both tissue and liquid biopsy NGS as standard of care. Based on a treatment schema defined by testing sufficiency, biomarker detection, and turnaround time (TAT), physicians based the majority of their treatments on liquid biopsy results (73.5%) versus tissue biopsy (25.9%). Liquid biopsy NGS returned results on average 26.8 days faster than tissue and reported higher testing success. For guideline-recommended biomarkers, liquid biopsy was 94.8% to 100% concordant with tissue. In comparing testing modalities, a liquid-first approach identified guideline-recommended biomarkers in 76.5% of patients versus 54.9% in a tissue-first approach. There was no significant difference in time-to-treatment, or survival outcomes (overall survival and progression free survival) based on liquid versus tissue biopsy findings. This research demonstrates that liquid biopsy NGS is an effective tool to capture actionable genetic alterations in NSCLC. Due to its high concordance to tissue, faster TAT, and similarity in outcomes and time-to-treatment, liquid biopsy can be used either as a first-line test or concordantly with tissue biopsy to guide treatment decisions in NSCLC.
在过去的十年中，随着针对特定遗传改变的多种疗法的批准，非小细胞肺癌 (NSCLC) 的治疗得到了改善。虽然下一代测序 (NGS) 传统上是从组织活检样本中进行的，但不断发展的数据支持使用基于血浆的循环肿瘤 DNA (ctDNA)，也称为“液体活检”，来补充组织活检方法，以指导一线治疗。这项研究回顾性分析了在 5 年内接受组织和液体活检 NGS 作为标准治疗的 2 个癌症中心的 170 名新 NSCLC 患者。根据通过测试充分性、生物标志物检测和周转时间 (TAT) 定义的治疗方案，医生主要根据液体活检结果 (73.5%) 而不是组织活检 (25.9%) 来进行治疗。液体活检 NGS 的结果平均比组织活检快 26.8 天，且报告的检测成功率更高。对于指南推荐的生物标志物，液体活检与组织活检的一致性为 94.8% 到 100%。在比较检测方式时，液体优先方法在 76.5%的患者中识别出了指南推荐的生物标志物，而组织优先方法的这一比例为 54.9%。基于液体与组织活检结果，治疗时间或生存结果（总生存期和无进展生存期）没有差异。这项研究表明，液体活检 NGS 是一种有效的 NSCLC 检测方法，可以捕获可操作的遗传改变。由于其与组织具有高度一致性、更快的 TAT 以及与组织活检相似的结果和治疗时间，液体活检可以作为一线测试或与组织活检同时使用，以指导 NSCLC 的治疗决策。
