WCLC 2025 - Posters & ePosters-P2.06.85 Clinical Utility of a “Plasma 1st Approach” for Molecular Diagnosis Using ctDNA in Advanced Lung Cancer, NHS England Pilot

P2.06.85 Clinical Utility of a “Plasma 1st Approach” for Molecular Diagnosis Using ctDNA in Advanced Lung Cancer, NHS England Pilot

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This study evaluates the clinical utility of a "Plasma 1st" approach employing circulating tumor DNA (ctDNA) liquid biopsy (LB) for molecular diagnosis in advanced lung cancer, as piloted by NHS England. The initiative, recently commissioned for suspected lung cancer cases, aims to integrate LB early in the diagnostic pathway to expedite treatment decisions using national data collected from multiple UK regions between 2022 and 2024.<br /><br />Key findings showed that liquid biopsy offered a significantly faster median turnaround time (TAT) of 22 days compared to 32 days for traditional tissue biopsy (TB) (p < 0.001). Time to treatment analysis found only 23% of patients met the 31-day target from diagnosis to treatment decision, potentially influenced by the treatment lines and molecular testing delays. Survival analysis indicated a statistically significant association of faster TATs within 31 days with improved overall survival (HR 0.65, p = 0.02), though this benefit lost significance after adjusting for immortal time bias, suggesting no definitive survival advantage solely due to faster LB results.<br /><br />The study concludes that liquid biopsy is superior in operational efficiency, offering quicker results and a broader genomic profile, thus supporting earlier and improved clinical decision-making. While no clear survival benefit from faster LB results was observed, its clinical utility is high when integrated with updated treatment guidelines, allowing faster access to targeted therapies. The authors recommend further large-scale subgroup analyses to determine the full benefits of LB in routine clinical practice.<br /><br />Overall, the NHS England ctDNA pilot demonstrates that adopting a plasma-first diagnostic approach in advanced lung cancer is feasible and beneficial in reducing diagnostic delays and enhancing genomic characterization, though additional research is needed to confirm impacts on patient survival.

Asset Subtitle

Oliver Kennedy

Meta Tag

Speaker Oliver Kennedy

Topic Pathology and Biomarkers

Keywords

Plasma 1st approach

circulating tumor DNA

ctDNA

liquid biopsy

advanced lung cancer

NHS England

diagnostic turnaround time

treatment decision

overall survival

genomic profiling