Minimal Residual Disease Monitoring in Radically Treated Non-Small Cell Lung Cancer: Challenges and Future Directions

Abstract

Circulating tumor DNA (ctDNA) analysis can identify patients with residual disease before it is clinically or radiologically evident. Minimal residual disease (MRD) is an advancing area in the management of radically treated solid tumors. Which MRD assay is optimum and when it should be used is still not defined. Whilst promising, the clinical utility of this technology to guide patient care is still investigational in non-small cell lung cancer (NSCLC) and has not entered routine care. Once technically and clinically optimized, MRD may be utilized to personalize adjuvant therapy, detect disease relapse earlier and improve cure rates. In this review, we discuss the current status of MRD monitoring in NSCLC by summarizing frequently used MRD assays and their associated evidence in NSCLC. We discuss the potential applications of these technologies and the challenge of demonstrating MRD clinical utility in trials.

Keywords:

• MRD
• ctDNA
• NSCLC
• adjuvant therapy
• minimal residual disease
• non-small cell lung cancer
• circulating tumor DNA

Disclosure

Dr Andrew Feber is an employee of Nonacus. Professor Sanjay Popat reports personal fees from Amgen, personal fees from AstraZeneca, personal fees from Bayer, personal fees from Beigene, personal fees from Blueprint, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Daiichi Sankyo, personal fees from Guardant Health, personal fees from Incyte, personal fees from Janssen, personal fees from Lilly, personal fees from Merck Serono, personal fees from MSD, personal fees from Novartis, personal fees from Roche, personal fees from Takeda, personal fees from Pfizer, personal fees from Seattle Genetics, personal fees from Turning Point Therapeutics, personal fees from Xcovery, outside the submitted work. The authors report no other conflicts of interest in this work.