Liquid biopsy detects more mutations, shortens time to treatment in stage IV NSCLC
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CHICAGO — Including liquid biopsy in the initial diagnostic workup of patients with stage IV nonsquamous non-small cell lung cancer resulted in a quicker initiation of first-line therapy and a higher detection rate of actionable mutations.
These findings were presented at ASCO Annual Meeting, and patients undergoing liquid biopsy were compared with patients who received tissue-based molecular diagnostic testing.
“Tissue sequencing has been the gold standard, but we and others have demonstrated that layering in liquid biopsies in a concurrent fashion on tissue biopsies can improve our rate of detection of actionable alterations,” Charu Aggarwal, MD, MPH, Leslye M. Heisler associate professor for lung cancer excellence at University of Pennsylvania’s Abramson Cancer Center, told Healio. “In this abstract, we are demonstrating that when you do concurrent tissue and plasma sequencing, you can actually increase your rate of guideline-concordant testing.”
The retrospective cohort study analyzed data from a bank of Main Line Health patients who were diagnosed with stage IV nonsquamous NSCLC from 2014 to 2020. According to the abstract, the primary objective was to identify the actionable mutations detected in liquid biopsy compared with non-liquid biopsy testing. The secondary objective was to determine the time interval from testing to lung cancer identification and initiation of therapy.
“So, our patients underwent comprehensive molecular testing at a much higher extent when they were tested with both tissue and plasma. But the story doesn’t stop there, we found that patients who underwent comprehensive molecular testing had much higher survival than patients who did not, suggesting that if we provide guideline-concordant molecular testing, we can improve outcomes,” Aggarwal said. “Also, this is true for patients who underwent testing before the frontline setting, before first-line therapy was delivered where it’s extremely important to come in with the right therapy at the right time for the right patient.”
The study included 152 patients, with 68 undergoing liquid biopsy testing and 84 not undergoing liquid biopsy. Of the 68 patients in the liquid biopsy cohort, 50% (n = 34) did not have sufficient tissue biopsy for molecular diagnosis, but liquid biopsy detected actionable mutations in 44% (n = 15). This resulted in actionable mutations being detected in 41% (n = 28) patients in the liquid biopsy cohort compared with 21% (n = 18) in the non-liquid biopsy cohort.
Moreover, first-line treatment occurred an average of 48.3 days (median 40.5 days, range 13-317) in the liquid biopsy cohort compared with 72.7 days (median 50.5 days, range 14-534) in the non-liquid biopsy group.
“There’s a huge unmet need for improving our rates of comprehensive testing. Nationally, if you look at comprehensive molecular genotyping, it’s only 50%,” Aggarwal said. “Liquid biopsies are available, they’re FDA-approved. I think our results demonstrate that they can be easily integrated into the management of non-small cell lung cancer and can improve, not just testing but also survival.”
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Maity AP, et al. Abstract e20577. Presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
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