Circulating Tumor DNA Has Prognostic Value in NSCLC

Preoperative circulating tumor DNA (ctDNA) has prognostic value, especially for determining long-term prognosis for patients with lung adenocarcinoma and stage I and II NSCLC.

Moreover, the systemic review and meta-analysis showed that these patients also derived survival benefits from adjuvant therapy following surgery.

Jiamin Lu and colleagues reviewed 11 studies that included European and Asian populations. The primary end points of these studies were OS and recurrence-free survival (RFS).

Patients with NSCLC who expressed preoperative ctDNA had worse OS and RFS, and this outcome was especially true in patients with lung adenocarcinoma and stage I and II disease. However, there was no significant association observed in stage III patients. Furthermore, postoperative adjuvant therapy provided greater survival benefits to those with preoperative ctDNA compared with patients negative for preoperative ctDNA.

“Appropriate incorporation of preoperative ctDNA detection in the treatment strategy of NSCLC patients could assist in identifying the cases with a risk of relapse, thereby being useful in guiding the postoperative treatment strategies formulated for these patients,” the researchers concluded.

Despite the meta-analysis findings, the researchers say further validation is needed from future multicenter, high-quality, clinical trials with large sample sizes.

Despite Availability of Curative-Intent Treatment, Racial Disparities Persist Among Patients With NSCLC

Cancer Epidemiology, Biomarkers & Prevention. doi:10.1158/1055-9965.EPI-23-1182

Racial disparities persist in curative-intent treatment for early-stage NSCLC despite the availability of stereotactic body radiotherapy (SBRT), according to a population-based analysis.

Qinran Liu and colleagues investigated trends and disparities in receiving curative-intent surgery or SBRT in a diverse population, which was determined using the Florida Cancer Registry. The NSCLC cases included in the analysis were from 2005 to 2017 and evaluated nearly 65,000 patients.

The analysis showed that 71.6% of patients received surgery and/or SBRT. The racial/ethnic backgrounds of treatment were as follows: 73.1%, 72.4%, and 60.3% among Hispanic, White, and Black patients, respectively.

While SBRT showed an increase over the 12-year span, there was a decline in curative-intent surgery. From 2005 to 2007, the use of SBRT rose steeply and then continued to rise by 7.9% annually from 2007 to 2017. For surgery, usage remained stable from 2005 to 2014; however, it began to decline by 6.2% annually from 2014 to 2017.

A significant finding of the analysis was the Black-White disparity when it came to receiving curative-intent treatment. The researchers found that patients with Charlson Comorbidity Index (CCI) scores of ³3 had 36% lower odds of receiving curative-intent surgery compared with patients whose CCI was 0. For SBRT, there was no significant difference between patients with different CCI scores.

“Addressing disparities in early-stage NSCLC requires addressing differential treatment patterns and enhancing accessibility to treatments like underutilized SBRT, particularly for high-comorbidity populations such as Black patients,” the researchers said.