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. 2024 Oct 8;31(10):6017-6031.
doi: 10.3390/curroncol31100449.

Implementation of Liquid Biopsy in Non-Small-Cell Lung Cancer: An Ontario Perspective

Daniel Breadner  1 , David M Hwang  2 , Don Husereau  3 , Parneet Cheema  4   5 , Sarah Doucette  6 , Peter M Ellis  7   8 , Shaqil Kassam  9 , Natasha Leighl  5   10 , Donna E Maziak  11 , Shamini Selvarajah  12   13 , Brandon S Sheffield  14 , Rosalyn A Juergens  7   8
Affiliations

Implementation of Liquid Biopsy in Non-Small-Cell Lung Cancer: An Ontario Perspective

Daniel Breadner et al. Curr Oncol. .

Abstract

Lung cancer is the leading cause of cancer-related deaths in Canada, with non-small-cell lung cancer (NSCLC) accounting for the majority of cases. Timely access to comprehensive molecular profiling is critical for selecting biomarker-matched targeted therapies, which lead to improved outcomes in advanced NSCLC. Tissue biopsy samples are the gold standard for molecular profiling; however, several challenges can prevent timely and complete molecular profiling from being performed, causing delays in treatment or suboptimal therapy selection. Liquid biopsy offers a minimally invasive method for molecular profiling by analyzing circulating tumour DNA (ctDNA) and RNA (cfRNA) in plasma, potentially overcoming these barriers. This paper discusses the outcomes of a multidisciplinary working group in Ontario, which proposed three eligibility criteria for liquid biopsy reimbursement: (1) insufficient tissue for complete testing or failed tissue biomarker testing; (2) suspected advanced NSCLC where tissue biopsy is not feasible; and (3) high-risk patients who may deteriorate before tissue results are available. The group also addressed considerations for assay selection, implementation, and economic impact. These discussions aim to inform reimbursement and implementation strategies for liquid biopsy in Ontario's public healthcare system, recognizing the need for ongoing evaluation as technology and evidence evolve.

Keywords: circulating tumour DNA (ctDNA); liquid biopsy; molecular testing; non-small-cell lung cancer (NSCLC); targeted therapies.

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Conflict of interest statement

D.B. has accepted honoraria and/or speaking fees from Astra Zeneca, Amgen, Bristol-Myers Squibb, Takeda, Bayer, Guardant, Roche, Janssen, and Merck. D.M.H has accepted honoraria as a speaker for Amgen, Merck & Co Inc., F Hoffman-La Roche AG, Eli Lilly and Company, Novartis AG, AstraZeneca Canada Inc., Pfizer Inc., and GSK; participated in advisory boards for Boehringer-Ingelheim, Roche, Novartis AG, Merck & Co Inc., Amgen Inc., Bayer AG, Bristol-Myers-Squibb Co, and AstraZeneca Canada Inc.; and received grant funding from AstraZeneca Canada Inc., Boehringer-Ingelheim Canada Ltd., Pfizer Inc., and EMD Serono Inc. D.H. has accepted honoraria from Amgen Canada Inc., AstraZeneca Canada, Eli Lilly Canada Inc., GlaxoSmithKline Inc. (GSK Canada), Janssen Inc./J&J, Pfizer Canada ULC, Thermo Fisher Scientific Inc., and Roche Canada. P.C. has received honoraria and/or has participated in advisory board meetings with Amgen, AstraZeneca, Bristol Myers Squibb, Merck, Janssen, Bayer, Novartis, Pfizer, Roche, Sanofi, and Daiichi Sankyo. S.D. has received funding from AstraZeneca Canada for medical writing services. P.M.E. has accepted honoraria for speaking or advisory board meetings from AstraZeneca, Eli Lilly, Jannsen, Merck, Novartis, Roche, Sanofi, and Pfizer. S.K. has no conflicts of interest to declare. N.L. has received institutional research funding from Roche Canada, Guardant Health, MSD, EMD Serono, Lilly, AstraZeneca Canada, Takeda, Amgen, Bayer, and MSD Oncology and has accepted reimbursement for travel, accommodation, and/or expenses from Merck Sharp & Dohme. D.E.M. has no conflicts of interest to declare. S.S. has received test development grants and honoraria from AstraZeneca, Pfizer, Janssen, Incyte Biosciences, and Illumina. B.S.S. has received honoraria, received grant support, and/or participated in advisory meetings with Amgen, AstraZeneca, Bayer, Biocartis, Boehringer-Ingelheim, Cell Marque, Elevation Oncology, Eli Lilly, EMD Serono, Incyte, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, ThermoFisher, and Turning Point Therapeutics. R.A.J. has served in a consultancy or advisory role for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, EMD Serono, Merck, Novartis, Pfizer, Hoffmann-La Roche, Sanofi, and Takeda; has received honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, EMD Serono, Merck, Novartis, Pfizer, Hoffmann-La Roche, Sanofi, and Takeda; and has received institutional research funding from AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer.

Figures

Figure 1
Figure 1
Considerations for optimization along the liquid biopsy testing workflow [74,75,76]. cfDNA, cell-free DNA; ctDNA, circulating tumour DNA; ddPCR, digital drop polymerase chain reaction; EDTA, ethylenediaminetetraacetic acid; ER, emergency room.
Figure 2
Figure 2
Key messages from workgroup discussions on of test selection, implementation, and cost analysis/economics. NGS, next-generation sequencing; NSCLC, non-small-cell lung cancer.
See this image and copyright information in PMC

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