The Emerging Role of ctDNA in NSCLC Management

EP: 1.Treatment Approaches for Early-Stage Lung Cancer

EP: 2.Driving Precision Medicine Through Molecular Testing in NSCLC

EP: 3.Neoadjuvant/Perioperative Immunotherapy in NSCLC

EP: 4.Referral of Early-Stage NSCLC to Multidisciplinary Teams

EP: 5.Neoadjuvant, Adjuvant, and Perioperative Options in NSCLC

EP: 6.Updates in CheckMate-816 From ESMO 2023

EP: 7.AEGEAN Trial: Perioperative Approach in NSCLC

EP: 8.Latest From the NEOTORCH Trial & KEYNOTE-671 Trial

EP: 9.CheckMate-77T Trial Results From ESMO 2023

EP: 10.Treatment Decision Making by Stage for Resectable NSCLC

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EP: 11.The Emerging Role of ctDNA in NSCLC Management

EP: 12.Addressing Gaps in Care for Non-Small Cell Lung Cancer

This is a video synopsis/summary of a Precision Medicine featuring Patrick Forde, MBBCh, and Tina Cascone, MD, PhD.

Forde and Cascone discuss the role of PD-L1 status and circulating tumor DNA (ctDNA) clearance in guiding neoadjuvant immunotherapy decisions for non–small cell lung cancer (NSCLC). While PD-L1 expression appears to influence the degree of benefit from perioperative therapy, it is not a major factor in current decision-making. ctDNA clearance during neoadjuvant therapy has been associated with favorable pathologic responses in studies such as CheckMate -816 and AEGEAN. However, the use of ctDNA in clinical practice is not yet ready for implementation, pending more technologically advanced assays, faster turnaround times, and further data correlating ctDNA with pathologic response and long-term outcomes.

The decision to continue therapy after neoadjuvant treatment is influenced by factors such as the degree of pathologic response, tumor stage, and patient tolerability. Patients with a near pathologic complete response (pCR) (0% to 5% residual tumor) have a promising 2-year event-free survival of 90% with just 3 cycles of neoadjuvant therapy. For patients with a higher residual tumor burden, particularly those with stage III disease or larger tumors, continuation of adjuvant therapy may provide additional benefit. Patients who tolerate therapy well and achieve a pCR or near pCR often wish to continue treatment for the potential incremental benefit. In clinical trials, approximately 70% of patients start adjuvant therapy after preoperative treatment, with 30% to 40% completing the full course.

Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.