{"entity":{"id":"paper-aggarwal-plasma-genotyping-personalised-therapy-jama-oncol-2019","kind":"paper","name":"Clinical implications of plasma-based genotyping with the delivery of personalized therapy in metastatic non-small cell lung cancer","aka":[],"tldr":"Adding a blood test to routine practice nearly doubled the number of patients found to have a treatable mutation, and a third of those tested by blood alone were spared a biopsy.","summary":"A prospective cohort of 323 patients with metastatic non-small-cell lung cancer had plasma next-generation sequencing on a 73-gene platform ordered as part of routine clinical management. Therapeutically targetable mutations in EGFR, ALK, MET, BRCA1, ROS1, RET, ERBB2 or BRAF were detected in 113 patients overall, 35.0%. Ninety-four patients had plasma testing only, and a targetable mutation was found in 31 of them, 33.0%, sparing an invasive biopsy. Among the remaining 229 patients who had concurrent plasma and tissue testing or could not have tissue testing, a targetable mutation was detected in tissue alone for 47 patients, 20.5%, and the addition of plasma raised this to 82, 35.8%. Thirty-six of 42 patients treated on the basis of a plasma result achieved a complete or partial response or stable disease.","asOf":"2026-09-25","links":[{"label":"Aggarwal et al., JAMA Oncol 2019: plasma-based genotyping and the delivery of matched treatment in 323 metastatic lung cancers","url":"https://doi.org/10.1001/jamaoncol.2018.4305"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30325992/"}],"tags":[],"related":[],"cancers":["nsclc"],"sections":[],"technologies":["liquid-biopsy","cgp"],"targets":["egfr","alk","met","ros1","ret","her2","braf"],"drugs":[],"companies":[],"institutions":[],"pathways":["rtk-activation"],"terms":["ctdna","cfdna","ngs","biopsy"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jama-oncology"],"dependsOn":[],"notes":[],"journal":"JAMA Oncology","year":2019,"doi":"10.1001/jamaoncol.2018.4305","pmid":"30325992","authors":"Aggarwal C, Thompson JC, Black TA, et al.","paperType":"observational","findings":["Targetable mutations in 35.0% of patients overall with plasma sequencing in routine use.","Plasma-only testing found a targetable mutation in 33% of those patients, avoiding a biopsy.","Adding plasma to tissue raised detection from 20.5% to 35.8%.","Thirty-six of 42 patients treated on a plasma result responded or remained stable."],"whatItMeans":"It showed the benefit of plasma testing is not only analytical but logistical: it reaches patients who are too unwell, or whose disease is too inaccessible, for a repeat biopsy.","caveats":["Single centre, not randomised, and testing was at physician discretion.","Allele fraction did not correlate with depth of response.","Median follow-up was seven months."],"changedPractice":true,"participants":323},"route":"/key-papers/paper-aggarwal-plasma-genotyping-personalised-therapy-jama-oncol-2019/","neighbours":{"cancer":[{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"technology":[{"id":"cgp","kind":"technology","name":"Comprehensive genomic profiling","route":"/technologies/cgp/"},{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"}],"target":[{"id":"alk","kind":"target","name":"ALK","route":"/targets/alk/"},{"id":"braf","kind":"target","name":"BRAF","route":"/targets/braf/"},{"id":"egfr","kind":"target","name":"EGFR","route":"/targets/egfr/"},{"id":"her2","kind":"target","name":"HER2","route":"/targets/her2/"},{"id":"met","kind":"target","name":"MET","route":"/targets/met/"},{"id":"ret","kind":"target","name":"RET","route":"/targets/ret/"},{"id":"ros1","kind":"target","name":"ROS1","route":"/targets/ros1/"}],"pathway":[{"id":"rtk-activation","kind":"pathway","name":"Receptor tyrosine kinase activation","route":"/pathways/rtk-activation/"}],"term":[{"id":"biopsy","kind":"term","name":"Biopsy","route":"/terms/biopsy/"},{"id":"cfdna","kind":"term","name":"Cell-free DNA (cfDNA)","route":"/terms/cfdna/"},{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"ngs","kind":"term","name":"Next-generation sequencing (NGS)","route":"/terms/ngs/"}],"journal":[{"id":"jama-oncology","kind":"journal","name":"JAMA Oncology","route":"/journals/jama-oncology/"}]}}