WCLC 2025 | What does the future hold for ctDNA testing in lung cancer?

There are a number of challenges and issues for a start, it’s great, but not every center is doing it in every patient that’s suitable, and I think there are bandwidth and constraint issues associated with that. It’s very manpower-heavy, so it needs a lot of people to ensure that this happens. We need to embed it completely into routine hospital systems in the same way as a physician or as a full blood count. They should be able to order a ctDNA in the same way a patient has a blood draw, and the blood makes its way to the central laboratory, and the report appears. At the moment, it’s very clunky, the process, and can certainly be optimized. We need to ensure that patients are having the blood taken very early in the diagnostic pathway, right at the time at which they present, not after a tissue diagnosis, because the health economics are all based on having the blood draw right at the beginning of the pathway. And, for example, if the patient already has an established target identified, do we really need to have repeat testing of the tissue with NGS? Probably not. And, indeed, the health economics of the case are contingent on not needing to test the tissue if you already have an informative specimen from the ctDNA. So, understanding what an informative specimen is really important, and in parallel to that, there’s a big education piece, because this is a new area for many oncologists, for many nurse specialists, for many pulmonologists, for respiratory physicians. We need to ensure that the entire workforce is up to speed with how to interpret these genetic reports, which can be sometimes complex.

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