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. 2024 Nov;19(11):1512-1524.
doi: 10.1016/j.jtho.2024.07.002. Epub 2024 Jul 9.

Clinical Utility of Tumor-Naïve Presurgical Circulating Tumor DNA Detection in Early-Stage NSCLC

Tae Hee Hong  1 , Soohyun Hwang  2 , Abhijit Dasgupta  3 , Chris Abbosh  4 , Tiffany Hung  5 , Jörg Bredno  5 , Jill Walker  6 , Xiaojin Shi  7 , Tsveta Milenkova  8 , Leora Horn  7 , Joon Young Choi  9 , Ho Yun Lee  10 , Jong Ho Cho  11 , Yong Soo Choi  11 , Young Mog Shim  11 , Shoujie Chai  5 , Kate Rhodes  5 , Manami Roychowdhury-Saha  5 , Darren Hodgson  12 , Hong Kwan Kim  11 , Myung-Ju Ahn  13
Affiliations

Clinical Utility of Tumor-Naïve Presurgical Circulating Tumor DNA Detection in Early-Stage NSCLC

Tae Hee Hong et al. J Thorac Oncol. 2024 Nov.

Abstract

Objectives: The use of tumor-informed circulating tumor DNA (ctDNA) testing in patients with early-stage disease before surgery is limited, mainly owing to restricted tissue access and extended turnaround times. This study aimed to evaluate the clinical value of a tumor-naïve, methylation-based cell-free DNA assay in a large cohort of patients with resected NSCLC.

Method: We analyzed presurgical plasma samples from 895 patients with EGFR and anaplastic lymphoma kinase-wild-type, clinical stage I or II NSCLC. The ctDNA status was evaluated for its prognostic significance in relation to tumor volume, metabolic activity, histologic diagnosis, histologic subtypes, and clinical-to-pathologic TNM upstaging.

Results: Presurgical ctDNA detection was observed in 55 of 414 patients (13%) with clinical stage I lung adenocarcinoma (LUAD) and was associated with poor recurrence-free survival (2-year recurrence-free survival 69% versus 91%; log-rank p < 0.001), approaching that of clinical stage II LUAD. Presurgical ctDNA detection was not prognostic in patients with clinical stage II LUAD or non-LUAD. Within LUAD, tumor volume and positron emission tomography avidity interacted to predict presurgical ctDNA detection. Moreover, presurgical ctDNA detection was predictive of the postsurgical discovery of International Association for the Study of Lung Cancer grade 3 tumors (p < 0.001) and pathologic TNM upstaging (p < 0.001). Notably, presurgical ctDNA detection strongly correlated with higher programmed death-ligand 1 expression in tumors (positive rates 28% versus 55%, p < 0.001), identifying a subgroup likely to benefit from anti-programmed death-ligand 1 therapies.

Conclusion: These findings support the integration of ctDNA testing into routine diagnostic workflows in early-stage NSCLC without the need for tumor tissue profiling. Furthermore, it is clinically useful in identifying patients at high risk who might benefit from innovative treatments, including neoadjuvant immune checkpoint inhibitors.

Keywords: Cancer detection; Cell-free DNA; NSCLC; Recurrence; Staging.

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Conflict of interest statement

Disclosure Dr. Dasgupta is a full-time employee of and owns stock in AstraZeneca. Dr. Abbosh is a full-time employee of and owns stock in SAGA Diagnostics and holds patents/patent applications in minimal residual disease detection (PCT/GB2017/053289, PCT/US2017/028013 and PCT/EP2022/077987). Dr. Hung is a full-time employee of GRAIL, LLC and owns stock in Illumina, Inc. Dr. Bredno is a full-time employee of GRAIL, LLC and owns stock in Illumina, Inc, and holds IP from Philips Medical Systems (with remuneration) and Roche (no remuneration). Dr. Walker is a full-time employee of and owns stock in AstraZeneca. Dr. Shi is a full-time employee of and owns stock in AstraZeneca. Dr. Milenkova is a full-time employee of and owns stock in AstraZeneca. Dr. Horn is a full-time employee of and owns stock in AstraZeneca. Dr. Chai is a full-time employee of GRAIL, LLC and owns stock in Illumina, Inc. Rhodes is a full-time employee of GRAIL, LLC and owns stock in Illumina, Inc. Dr. Roychowdhury-Saha is a full-time employee of GRAIL, LLC and owns stock in Illumina, Inc. Dr. Hodgson is a full-time employee of and owns stock in AstraZeneca. Dr. Ahn reports advisory board participation for AstraZeneca, Yuhan, Arcus, Takeda, Amgen, MSD, Merck, Daiichi-Sankyo, Alpha Pharmaceuticals, Pfizer, Voronoi, and Eutilex and advisory roles for AstraZenceca, Yuhan, Arcus, Takeda, Amgen, MSD, Merck, Daiichi-Sankyo, Alpha Pharmaceuticals, and Pfizer. The remaining authors declare no conflict of interest.

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