When to
Test
At Time of Diagnosis
Are Traditional Care Pathways Keeping Up With Precision Medicine?
Targeted therapies have revolutionized NSCLC care, improving survival by up to 50% (PMC). Yet, up to 70% of patients never receive them—not because they don’t qualify, but because of delayed or incomplete molecular testing (JCO Precision Oncology, Clinical Lung Cancer).
Are You Seeing the Full Picture?
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PD-L1 IHC Alone is Not Enough – Limited tumor access and heterogeneity leads to misclassified immune status, causing ineffective treatments and unnecessary toxicity (ScienceDirect, JTO).
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Early-stage Matters – The standard approach to molecular testing has long focused on advanced disease, but that mindset is now outdated. With the rise of neoadjuvant targeted and immunotherapy options, failing to assess PD-L1 and ctDNA status in early-stage patients is a missed opportunity for better outcomes.
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Unecessary Delays Are Unacceptable – Standard tissue genotyping takes up to 5 weeks and waiting for oncology to draw the liquid biopsy wastes weeks of valuable time, forcing oncologists to delay treatment decisions as they await critical molecular data (BMJ, PMC).
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Limited Tumor Access is a Problem – Limited or heterogeneous tissue samples leads to missed mutations and suboptimal therapy choices (Clinical Lung Cancer).
Neoadjuvant Treatment: A Clear Survival Advantage
Study: Martins et al. (Read More)
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3-Year Overall Survival:
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77% Neoadjuvant vs. 68% Adjuvant
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Complete Pathologic Response in 25% of neoadjuvant cases
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Downstaging in 32.5% of patients
What This Means in Practice:
When ctDNA is detected before surgery, the tumor biology is likely more aggressive. The evidence supports neoadjuvant chemoimmunotherapy as the better choice as a treatment decision backed by survival data. Clearance of ctDNA after neoadjuvant chemoIO Rx has shown to be an even better predictor of OS than pCR.
At 6-8 Weeks Post Treatment
Predicting Relapse Before It Happens
Study: Tran et al. (Read More)
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Persistent ctDNA after surgery correlates strongly with recurrence risk.
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Combining ctDNA with tumor volume assessments improves risk stratification.
What This Means in Practice:
For patients with detectable ctDNA post-op, simply watching and waiting is not enough. When 30% of stage I lung cancers will recur post-surgery, the data supports a proactive approach—whether through closer surveillance or additional systemic therapy—to get ahead of recurrence before it manifests clinically.
When Assessing for Recurrence or Progression
The cancer or the patient’s response to treatment changes over the course of therapy and time. When there is a symptomatic or radiographic concern, liquid biopsy could benefit to understand the recurrence or progressing cancer which could result in an adaptive treatment approach.