WCLC 2025 | Rolling out ctDNA ‘blood-first’ testing for lung cancer in England

Well, we are very lucky here in England because we are, as far as I know, the only European country to have core-funded ctDNA through a healthcare system. And that is not at the time of diagnosis, but at the time of presentation with metastatic disease. And this is now fully nationally funded by NHS England. And so at the time of presentation, either in the outpatient setting or if hospitalised as an emergency, if a patient has a CT scan which demonstrates advanced lung cancer suspected on the CT scan, such as stage three or stage four, the patient is eligible to have a blood draw for ctDNA. The current providers are a FoundationOne liquid test or a Marsden 360 test, which is very similar to the Guardant 360 ctDNA NGS test. The test is funded to occur in patients who present at the time of presentation. And if a patient has missed that opportunity and undergone tissue diagnosis, and that’s failed. It’s also an opportunity for testing in that scenario. The rollout has been very good, and we’re now trying to optimize the pathway to ensure that all eligible patients are tested. It’s been done very well in collaboration with our respiratory pulmonology colleagues, and in many centers this wouldn’t have happened without the direct support of our lung cancer nurse specialists who really are our patient advocates and have really got together to get this program off the ground and to deliver it and you know we see meaningful benefits every day patients’ cases are allowed and recommended to be discussed in a regional molecular tumor board or a genomic tumor advisory board because we recognize that many oncologists don’t have the genomic expertise to appropriately interpret these results which can sometimes be straightforward and sometimes complex. In addition we’ve also issued guidance which is available on the BTOG website as to how to interpret the results, when you can action the results to prescribe a targeted therapy if you have a tier one actionable genotype and what defines an informative negative result when you have confidence that you don’t have a tier one drugable genotype and that patient is suitable for immunotherapy with or without chemotherapy. So there’s a lot happening in this space. It’s fantastic. I see that it’s really transforming outcomes for our patients and I’m delighted to have this available for our patients.

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