Liquid NGS helps prolong survival in patients with advanced solid tumours

Patients with advanced solid tumours who have been treated according to matched targetable genomic mutation exhibit significantly longer overall survival than those who received standard-of-care (SOC) treatment, according to a Philippines study presented at ESMO Asia 2023.

“The clinical utility of next-generation sequencing (NGS) is not yet well documented in the Philippines,” said study co-author Dr Omar Maaño from the Section of Medical Oncology, St Luke’s Medical Center, Quezon City, Philippines. “Liquid NGS is usually indicated for treatment selection and is done if a tissue biopsy is not possible and the specimen is insufficient.”

Maaño and his colleague C Dy, also from the same institution, conducted this retrospective cross-sectional study to determine the applicability of liquid biopsy-based NGS in the local setting and if this justified the financial burden of ordering the test, the actual impact on selecting signal-matched therapies, and subsequent survival effects.

The two authors obtained data among adult patients with advanced solid tumours who underwent FoundationOne Liquid CDx at St Luke’s Medical Center between January 2018 and December 2022.

Overall, 125 patients were enrolled in this study, most of whom had lung tumour (n=40, 32 percent), followed by colon (n=25, 20 percent) and breast (n=15, 12 percent). The most frequently appearing gene was TP53, which was found in 54 percent (n=68) of the analysed samples. Previous systemic treatments among patients had a mean number of 1.96. [ESMO Asia 2023, abstract 429P]

Maaño and Dy identified 58 (46.6 percent) patients with actionable genomic mutations. Of the patients, 28 (22.4 percent) received treatment according to matched targetable genomic mutations, while the remaining participants (n=89, 71.2 percent) received SOC regimens.

The median overall survival (OS) for the entire cohort was 49 months (95 percent confidence interval [CI], 41.63‒56.37). Patients in the matched therapy group showed a significantly longer median OS (72 months, 95 percent CI, 37.64‒106.36) compared to those in the unmatched therapy group (29 months, 95 percent CI, 9.46‒48.54).

On the other hand, the median OS in the standard therapy group (n=61) was 46 months (95 percent CI, 37.31‒54.69). A significant difference among treatment groups was observed based on the overall comparison statistics (p=0.010).

“Liquid biopsy may represent a less invasive and more feasible alternative to tissue biopsy in bringing personalized cancer treatment to routine clinical practice and potentially benefit patients in the future,” Maaño and Dy said.

Budget impact

In an earlier study, researchers in Canada described the health and budget impact of alternative liquid-biopsy-based comprehensive genomic profile testing in tissue-limited patients from a publicly funded healthcare perspective. An economic model was developed to calculate the incremental cost and life-years gained as a population when adopting this method.

Results showed that a liquid-biopsy-based comprehensive genomic profile testing had an overall impact of $14.7 million with 168 life-years gained to the Canadian publicly funded healthcare system in the 3-year time horizon. [Curr Oncol 2021;28:5278-5294]