Prediagnosis Liquid Biopsy and Genetic Profiling Uptake Low in Advanced NSCLC

A study of real-world data found that comprehensive genome profiling (CGP) of early liquid biopsy (LBx) in anticipation of pathologic advanced non-small-cell lung cancer (aNSCLC) diagnosis was rare. These findings were published in JCO Precision Oncology.

Delivery of the most effective therapies in aNSCLC requires comprehensive genome profiling, however, many patients receive first-line therapy prior to genetic testing.

To evaluate real-world uptake of early LBx, investigators from Icahn School of Medicine at Mount Sinai sourced the Flatiron Health-Foundation Medicine clinicogenomic database (CGDB). The CGDB contains data from patients with aNSCLC receiving treatment at approximately 280 sites in the United States. For this study, 1076 patients with aNSCLC diagnosed between 2018 and 2023 who underwent LBx were assessed for LBx timing.

Overall, LBx was performed in 5% of patients prior to diagnosis and in 95% after diagnosis. The pre- and postdiagnosis groups were median ages 73 and 70 years, 43% and 51% were women, 73% and 73% were White, and 79% and 80% had a history of smoking, respectively.

Patients who underwent LBx prior to diagnosis received first-line treatment earlier than did those who underwent postdiagnosis LBx (median, 21 vs 35 days; P <.001).

Among the subset of 56 patients with early LBx who were positive for an actionable driver, 10 patients received first- or second-line therapy that matched their driver mutation. This cohort had a real-world time to treatment discontinuation of 11 months and partial or complete response rate of 71%.

This study was limited by its lack of comprehensive genome profiling data from all patients.

“LBx before pathological diagnosis confirmation might be well suited for patients presenting with clinical evidence of advanced cancer with urgency to initiate treatment, in parallel with routine diagnostic workup and staging, as one tool to accelerate the diagnostic odyssey and improve delivery of precision cancer care,” the study authors noted in their conclusion.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.