Updates on Liquid Biopsy for Advanced NSCLC: A Consensus Statement from the IASLC-IASLC LiqBx Webinar Slides

IASLC LiqBx Webinar Slides

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In the first case presented, a 58-year-old woman with advanced non-small cell lung cancer (NSCLC) is evaluated. Imaging reveals lung, liver, and bone metastases, and a lung fine needle aspiration (FNA) confirms adenocarcinoma. The question is raised as to the appropriate systemic therapy at this time. Options include starting immunotherapy alone, starting immunotherapy plus chemotherapy, starting chemotherapy alone, awaiting tissue-based molecular results, initiating liquid biopsy testing and awaiting results, or initiating chemotherapy alone while also initiating liquid biopsy testing. The speaker, Natasha Leighl, discusses the use of liquid biopsy in clinical practice. The potential barriers to molecular testing, including cost, lack of tissue, and lack of awareness of guidelines, are highlighted. The importance of broad molecular testing in patients with advanced NSCLC is emphasized, as it can provide valuable information about actionable targets and help guide treatment decisions. The speaker presents data from a study evaluating the use of liquid biopsy in advanced NSCLC patients in the Canadian public healthcare system. The results show that liquid biopsy identified actionable targets in a significant proportion of patients and had a high concordance with tissue-based testing. Liquid biopsy also had a shorter turnaround time compared to tissue profiling. The clinical outcomes, including response rate and progression-free survival, were comparable between patients with actionable alterations identified by liquid biopsy and tissue testing. The economic analysis showed that the use of liquid biopsy in addition to tissue biopsy was cost-effective in the Canadian public system. In the second case presented, a 52-year-old female with advanced NSCLC harboring an EGFR exon 19 deletion mutation is evaluated. The use of liquid biopsy to monitor the response to targeted therapy and detect acquired resistance mutations is discussed. The case demonstrates the potential of liquid biopsy to guide treatment decisions and optimize patient outcomes. In the third case presented, a 64-year-old male with stage IV lung adenocarcinoma is evaluated. The patient has inadequate tissue for next-generation sequencing and undergoes plasma-based comprehensive genomic profiling. The results reveal KRAS G12C and STK11 mutations, as well as low PD-L1 expression. The treatment options and therapeutic landscape for patients with this mutation profile are discussed. The importance of upfront comprehensive genomic profiling and consideration of the molecular profile in treatment decision-making is emphasized.

Keywords

non-small cell lung cancer

metastases

adenocarcinoma

systemic therapy

immunotherapy

chemotherapy

liquid biopsy

molecular testing

actionable targets

treatment decisions