Clinical Implications of Plasma-Based Genotyping With the Delivery of Personalized Therapy in Metastatic Non-Small Cell Lung Cancer.

摘要: Importance The clinical implications of adding plasma-based circulating tumor DNA next-generation sequencing (NGS) to tissue NGS for targetable mutation detection in non–small cell lung cancer (NSCLC) have not been formally assessed. Objective To determine whether plasma testing was associated with improved and enhanced delivery personalized therapy a real-world setting. Design, Setting, Participants This prospective cohort study enrolled 323 patients metastatic NSCLC who had ordered as part routine management. Plasma performed using 73-gene commercial platform. Patients were at the Hospital University Pennsylvania from April 1, 2016, through January 2, 2018. database locked follow-up analyses on 2018, median 7 months (range, 1-21 months). Main Outcomes Measures number alterations detected NGS; association between allele fractions (AFs) mutations plasma; response rate AF targeted mutations. Results Among (60.1% female; age, 65 years [range, 33-93 years]), therapeutically inEGFR,ALK,MET,BRCA1,ROS1, RET, ERBB2,orBRAFfor 113 (35.0%) overall. Ninety-four (29.1%) only discretion treating physician or patient preference. 94 alone, 31 (33.0%) detected, thus obviating need an invasive biopsy. remaining 229 concurrent unable NGS, alone 47 (20.5%), whereas addition increased this 82 (35.8%). Thirty-six 42 (85.7%) received based result achieved complete partial stable disease. no correlation depth Response Evaluation Criteria Solid Tumors (r = −0.121;P = .45). Conclusions Relevance Integration into management stage IV demonstrates marked increase molecularly guided therapy.