The lungs can be a difficult organ to biopsy with a needle, so the promise of identifying lung cancer through a blood-based biopsy has lung cancer experts and patients optimistic. Knowing how and when to use a liquid biopsy is critically important and led global experts at the International Association for the Study of Lung Cancer (IASLC) to issue “The IASLC Statement Paper: Liquid Biopsy for Advanced Non-Small Cell Lung Cancer (NSCLC),” now available online in the Journal of Thoracic Oncology.
“Liquid biopsy and its subsequent molecular analysis is a powerful tool that can determine the patient’s molecular tumor profile in order to determine the best therapeutic option and can be applied as an alternative to tissue testing in cases where tumor testing is not possible or tissue is not adequate,” said Fred R. Hirsch, MD, Ph.D., and CEO of the IASLC. “Gathering experts to collect and interpret a vast amount of information and to distribute best practices ensures that general oncologists and clinicians have access to the latest and best information in the emerging field of liquid biopsies.”
Historically, tissue biopsy specimens have been the sole source of tumor molecular information, but unfortunately, adequate tissue is not always easy to obtain from all patients with advanced NSCLC. In addition, the need to monitor responses to treatment and to identify emergent molecular mechanisms of resistance are increasingly important but are limited by the challenges of traditional tissue rebiopsies. In this context, the isolation of tumor-derived DNA, RNA and cells from the peripheral circulation (a concept termed liquid biopsy) is emerging as a versatile and powerful tool for the optimization of NSCLC clinical management via the identification of predictive biomarkers, either prior to treatment or at progression.
In just the past decade, tremendous advances in the treatment of metastatic non-small cell lung cancer (NSCLC) have been made due to the identification of targetable oncogenic molecular drivers on which the tumors are dependent for their growth and survival. Precision oncology—treating the patient with therapies predicted to be effective based on the specific molecular characteristics of their tumor—can add years of quality life for those patients. Ensuring that oncologists worldwide have access to these advances is critical to ensuring that all patients have access to the latest treatments.
For this reason, the International Association for the Study of Lung Cancer (IASLC) convened a multidisciplinary panel of thoracic oncology experts with interest and expertise in liquid biopsy and molecular pathology to evaluate currently available evidence with the aim of producing a set of recommendations for the use of liquid biopsy for molecular analysis in guiding the clinical management of advanced NSCLC patients as well as identifying unmet needs.
The possibility of using a non-invasive method to understand and identify molecular targets and mechanisms of resistance for current drugs, both targeted agents and immunotherapies, will be extremely beneficial for patients, as will harnessing these strategies to identify new biomarkers. The future of liquid biopsies is undeniably exciting, but there is a need to more clearly understand the latest developments.
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