The Role of Liquid Biopsy in the Diagnostic Testing Algorithm for Advanced Lung Cancer
1
Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
2
Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
Onco 2022, 2(3), 181-185; https://doi.org/10.3390/onco2030012
Submission received: 26 May 2022
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Revised: 6 July 2022
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Accepted: 12 July 2022
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Published: 14 July 2022
(This article belongs to the Special Issue Feature Papers in Onco)
Simple Summary
The utility, feasibility, and cost-effectiveness of upfront tissue next-generation sequencing (NGS) for advanced non-small cell lung cancer (NSCLC) have been previously demonstrated. However, significant limitations with tissue NGS remain such as insufficient tissue, scheduling limitations, the need for repeat biopsies, and long turnaround times. This leads to delays in commencing appropriate first-line therapy, particularly in patients without a targetable alteration. Liquid biopsies, using plasma circulating tumor DNA (ctDNA), have the potential to overcome these issues. This paper puts forth the rationale for liquid biopsy as a complementary diagnostic assay in the diagnostic algorithm for advanced lung cancer.
Abstract
The discovery of therapeutically targetable oncogenic driver alterations has led to marked improvements in NSCLC outcomes. Targeted agents have been approved for an expanding list of biomarkers. Consequently, the accurate and timely identification of targetable alterations with diagnostic molecular profiling is crucial. The use of multiplexed tissue assays, such as next-generation sequencing (NGS), has increased significantly. However, significant limitations with tissue NGS remain, such as insufficient tissue, scheduling limitations, the need for repeat biopsies, and long turnaround times. Liquid biopsies, using plasma circulating tumor DNA (ctDNA), have the potential to overcome these issues, with simpler sample processing requirements, greater convenience, and better patient acceptability. In particular, an early liquid biopsy may allow patients access to highly effective therapies faster, allow better symptom control and quality of life, prevent rapid clinical deterioration, and reduce patient anxiety at diagnosis. More broadly, it may also allow for the more cost-effective delivery of healthcare to patients.
