Matched tissue and liquid biopsies for advanced non-small cell lung cancer patients A potentially indispensable complementary approach

The introduction of liquid biopsies (LB) has brought forth a number of therapeutic opportunities into the domain of thoracic oncology. Many of which have been adopted for care of patients presenting with advanced nonsquamous non-small cell lung cancer (aNS-NSCLC). For example, one of the most frequent indications to perform a LB in these patients, at least in Europe, is for patients treated with tyrosine kinase inhibitors (TKIs) targeting EGFR and ALK genomic alterations when the tumor progresses. A tissue biopsy (TB) must then be taken, ideally from a site of a tumor that progresses, in particular if the LB does not permit detection of a mechanism of resistance to TKI. A LB from a patient with aNS-NSCLC is recommended before first-line therapy if no tissue and/ or cytological material is accessible or if the extracted nucleic acid is insufficient in amount and/or of poor quality. At present a LB and a TB are rarely performed simultaneously before treatment and/or on tumor progression. This complementary/matched testing approach is still controversial but needs to be better evaluated to determine the true benefit to care of patients. This review provides an update on the complementarity of the LB and TB method for care of patients presenting with aNS-NSCLC.

Automated summary

The introduction of liquid biopsies has provided new therapeutic opportunities in thoracic oncology, especially for advanced nonsquamous non-small cell lung cancer patients. In Europe, liquid biopsies are frequently used for patients receiving tyrosine kinase inhibitors (TKIs) when tumor progression occurs. Tissue biopsies are necessary if the liquid biopsy fails to detect TKI resistance mechanisms. Liquid biopsy is recommended before first-line therapy if tissue or cytological material is inaccessible or insufficient in quantity or quality. Simultaneous performance of liquid biopsy and tissue biopsy before treatment or tumor progression is rare and its benefits to patient care need further evaluation. This review updates the complementarity of liquid biopsy and tissue biopsy for care of aNS-NSCLC patients.