Patients with advanced non-small cell lung cancer (NSCLC) may soon be offered a blood test to assess their treatment options, instead of having to provide a tumour sample for analysis.

Data from the Blood First Assay Screening Trial (BFAST) presented at the European Society for Medical Oncology (ESMO) Congress 2019 has shown that the test can identify DNA mutations in NSCLC patients by picking up tiny pieces of tumour DNA shed by cancer cells into the blood. This information can be used to assess patient suitability for targeted medicines.

In the BFAST analysis, over 2,200 patients with untreated NSCLC had blood tests to check for multimer genetic mutations. Overall, 119 of them were found to have tumour DNA showing a rearrangement of the ALK gene.

Alectinib, a cancer treatment that targets the ALK mutation, was given to 87 of these patients. A year on, 87% of these patients had responded to the treatment, with 78% exhibiting no further progression of their disease.

BFAST study author Dr Shirish Gadgeel said: “Liquid biopsy identified a similar proportion of patients with ALK mutations to that typically seen with traditional biopsy and the results with alectinib compared well with those seen in a pivotal study of this treatment.”

Clinicians’ ability to identify the individual genetic mutations driving the progression of NSCLC has been a major breakthrough in oncology. However, this information is typically gleaned through a tumour sample, and obtaining these remains a major challenge.

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University of Turin oncology professor Alverto Bardelli said: “It is encouraging to see that increasing numbers of patients with lung cancer can benefit from liquid biopsy to identify their disease mutation instead of tissue samples.

“At present the technology is quite expensive but as it becomes more widely used, the cost is likely to come down so that testing becomes more affordable and available in daily practice.”