Identifying patients with high risk stage I NSCLC using tumor-informed plasma ctDNA: multicenter prospective study

Management of early stage non-small cell lung cancer (NSCLC) remains challenging with a high rate of disease recurrence. A multicenter prospective cohort study investigated the possibility to identify patients with high risk clinical stage I NSCLC using tumor-informed plasma circulating tumor DNA (ctDNA) analysis. The cohort consisted of 153 patients (75.8% pathological stage I), who underwent real-time plasma ctDNA testing. Preoperative ctDNA was detected in 22.4% of patients (6 weeks median turnaround time) and was significantly associated with recurrence-free survival (RFS, HR 3.81; p=0.006). The 2-year RFS rate was 84.2%, with inferior outcomes among patients with detectable preoperative ctDNA (69.1%). In pathological stage I NSCL:C, preoperatoive ctDNA detection and invasive tumor size remained independently associated with RFS. The authors conclude that these data demonstrate the clinical feasibility of using ctDNA data to inform treatment decision-making in stage I NSCLC.