The use of minimal residual disease in thoracic oncology: Gaps between promises and the on-the-ground reality of daily practice

The assessment of minimal residual disease (MRD) from blood samples of patients with resected non-small cell lung carcinoma (NSCLC) is promising and opens up many opportunities for the optimisation of patient care in daily practice. Notably, this includes the potential for escalation or de-escalation of adjuvant therapies. Thus, the evaluation of MRD status can directly contribute to an increase in the overall survival of early stage NSCLC patients and/or limit therapeutic but also financial toxicity. Therefore, several clinical trials recently evaluated MRD in early stage NSCLC by integrating and retrospectively comparing the results of MRD assessments. In this context, there is an urgent need to close the gap between clinical research and the use of the evaluation of MRD in routine daily practice. Further action needs to be taken, particularly in evaluating the pertinence of the detection of MRD in prospective interventional clinical studies. This may be done in part by comparing different parameters, such as the techniques used, the different time points and the cutoffs of MRD assessments. This article investigates the assessment of MRD in non-small cell lung cancers, with a special focus on the issues associated with the various assays and the limitations of using circulating free DNA analyses for MRD assessment in early stage lung cancer. Recommendations and tips for the optimisation of MRD evaluation in non-small cell lung cancers are provided.

Automated summary

The assessment of minimal residual disease (MRD) from blood samples has potential in optimizing patient care for resected non-small cell lung carcinoma (NSCLC). Evaluating MRD status can improve overall survival for early stage NSCLC patients and reduce the toxic effects and financial burden of treatment. Clinical trials have examined MRD in early stage NSCLC, highlighting the need to bridge the gap between research and routine practice. Further action is necessary to assess the relevance of MRD detection in interventional clinical studies, comparing different techniques, time points, and cutoffs. This article investigates and provides recommendations for optimizing MRD evaluation in NSCLC.