Dr. Rintoul on the Importance of MRD Assessment in NSCLC

Robert Rintoul, BSc, MB ChB, PhD, FRCP, reader in thoracic oncology, Department of Oncology, University of Cambridge, honorary respiratory physician, Royal Papworth Hospital NHS Foundation Trust, discusses the importance of minimal residual disease (MRD) assessment in patients with non–small cell lung cancer (NSCLC).

Surgical resection is generally associated with improved long-term survival in patients with stage I to IIIA NSCLC, says Rintoul. Moreover, earlier intervention appears to decrease the likelihood of recurrence.

Patients with stage I disease who undergo complete surgical resection do not receive adjuvant chemotherapy, explains Rintoul. However, adjuvant chemotherapy could be offered to patients with more advanced disease or lymph node involvement with the intent of eliminating residual disease.

While adjuvant chemotherapy is associated with improved survival, the majority of patients will experience some adverse effects, says Rintoul. Using MRD assessment to determine which patients are most likely to benefit from adjuvant chemotherapy could spare patients who are unlikely to derive benefit the associated toxicities.

As part of the 2020 AACR Virtual Annual Meeting II, preliminary findings from the prospective LUCID circulating tumor (ct)DNA study showed that with the novel RaDaR^TM assay, ctDNA could be detected at baseline or during follow-up in 72% of patients. ctDNA was detected 6 to 12 months before clinical progression in 60% of patients where samples were available within that time period.

Moreover, patients who had ctDNA detected post-treatment had poorer outcomes compared with patients who were ctDNA negative following treatment