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J Thorac Oncol. 2018 Sep;13(9):1248-1268. doi: 10.1016/j.jtho.2018.05.030. Epub 2018 Jun 6.

Liquid Biopsy for Advanced Non-Small Cell Lung Cancer (NSCLC): A Statement Paper from the IASLC.

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Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland.
University of California Davis Comprehensive Cancer Center, Sacramento, California.
University of Turin, Department of Oncology at San Luigi Hospital, Orbassano, Italy.
Department of Thoracic Oncology, The Netherlands Cancer Institute and Department of Pulmonary Disease, Academic Medical Center, Amsterdam, The Netherlands.
Multidisciplinary Oncology and Therapeutic Innovations Department, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France.
Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California.
Yale Cancer Center, New Haven, Connecticut.
State Key Laboratory of South China, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, China.
Institute of Oncology, Soroka Medical Center and Ben Gurion University, Beer Sheva, Israel.
Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Memorial Cancer Institute, Memorial Healthcare System/Florida International University (FIU) Miami, Florida.
Department of Thoracic Oncology, Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts.
University Health Network and Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Brigham and Women's Hospital and Department of Pathology, Harvard Medical School, Boston, Massachusetts.
National Cancer Centre Singapore and Genome Institute of Singapore, Singapore.
Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California.
Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
International Association for the Study of Lung Cancer, Aurora, Colorado.
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, and the International Association for the Study of Lung Cancer, Aurora, Colorado. Electronic address:


The isolation and analysis of circulating cell-free tumor DNA in plasma is a powerful tool with considerable potential to improve clinical outcomes across multiple cancer types, including NSCLC. Assays of this nature that use blood as opposed to tumor samples are frequently referred to as liquid biopsies. An increasing number of innovative platforms have been recently developed that improve not only the fidelity of the molecular analysis but also the number of tests performed on a single specimen. Circulating tumor DNA assays for detection of both EGFR sensitizing and resistance mutations have already entered clinical practice and many other molecular tests - such as detection of resistance mutations for Anaplastic Lymphoma Kinase (ALK) receptor tyrosine kinase rearrangements - are likely to do so in the near future. Due to an abundance of new evidence, an appraisal was warranted to review strengths and weaknesses, to describe what is already in clinical practice and what has yet to be implemented, and to highlight areas in need of further investigation. A multidisciplinary panel of experts in the field of thoracic oncology with interest and expertise in liquid biopsy and molecular pathology was convened by the International Association for the Study of Lung Cancer to evaluate current available evidence with the aim of producing a set of recommendations for the use of liquid biopsy for molecular analysis in guiding the clinical management of advanced NSCLC patients as well as identifying unmet needs. In summary, the panel concluded that liquid biopsy approaches have significant potential to improve patient care, and immediate implementation in the clinic is justified in a number of therapeutic settings relevant to NSCLC.


Biomarkers; Liquid biopsy; Molecular analysis; NSCLC; Resistance; Targeted therapies; cfDNA; ctDNA


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