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Testing a blood sample found at least as many treatable mutations as testing the tumour did, found them six days sooner, and when both were done together found half as many again.
Prospectively enrolled patients with previously untreated metastatic non-small-cell lung cancer undergoing physician-discretion standard-of-care tissue genotyping also submitted a pretreatment blood sample for comprehensive cell-free DNA analysis. Among 282 patients, tissue genotyping identified a guideline-recommended biomarker in 60 patients against 77 identified by cell-free DNA, 21.3% against 27.3%, meeting non-inferiority. In tissue-positive patients the biomarker was identified by tissue alone in 12 of 60 and concordantly in 48 of 60, an 80% clinical sensitivity for cell-free DNA. For the alterations with approved drugs, EGFR, ALK, ROS1 and BRAF, concordance exceeded 98% with 100% positive predictive value for cell-free DNA against tissue in 34 positive patients. Using cell-free DNA in addition to tissue increased detection by 48%, from 60 to 89 patients. Median turnaround was 9 days against 15 days for tissue, and guideline-complete genotyping was far more likely.
It is the evidence behind running plasma and tissue together at diagnosis rather than in sequence, and the 80% sensitivity figure is the reason a negative plasma result never ends the work-up.
Shares Biopsy, ROS1, Cell-free DNA (cfDNA), RET.
Shares Biopsy, ROS1, Cell-free DNA (cfDNA), RET.
Shares ROS1, RET, Next-generation sequencing (NGS), MET.
Shares Biopsy, Guardant360 CDx, Cell-free DNA (cfDNA), MET.
Shares RET, MET, ALK, Comprehensive genomic profiling.
Shares ROS1, Guardant360 CDx, ALK, Receptor tyrosine kinase activation.
Shares Guardant360 CDx, Cell-free DNA (cfDNA), Receptor tyrosine kinase activation, Circulating tumour DNA (ctDNA).