Tissue vs Plasma Biopsy After First Disease Progression in EGFR-Mutant NSCLC

EP: 1.The Evolution of EGFR-Mutated Advanced NSCLC Treatment: Present Considerations and Future Treatment Options

EP: 2.Has Combination Therapy Become the New Frontline Treatment Standard for EGFR-Mutant Metastatic NSCLC?

EP: 3.Decision Points to Consider When Choosing Treatment With Monotherapy or Combination Therapy for EGFR-Mutant mNSCLC

EP: 4.Evaluating Patient Preferences for the Treatment of EGFR-Mutant mNSCLC

EP: 5.Comparing the Combination Therapies for the Treatment of EGFR-Mutant mNSCLC

EP: 6.Considering Resistance Mechanisms When Choosing Therapy in the Frontline Setting

EP: 7.The Importance of Maintaining Quality of Life and Intervening Early When Adverse Events Occur in the Frontline Treatment Setting

EP: 8.Weighing the 1-Year Projected Overall Survival Benefit With MARIPOSA in the Frontline Treatment of EGFR-Mutant mNSCLC

EP: 9.Discussing the Time and Financial Toxicities Associated With Combination Therapies and Potential Mitigation Strategies

EP: 10.Discussing Potential Combination Therapy Medication-Associated Toxicities With Patients

EP: 11.Evaluating the Clinical Utility of Subcutaneous Amivantamab in the Treatment of EGFR-Mutant mNSCLC

EP: 12.The Importance of Multidisciplinary Collaboration With Subspecialty Physicians in the Toxicity Management With Treatment

EP: 13.Exploring Second-Line Treatment Options Including Targeted Radiation and Surgery for the Management of EGFR-Mutant mNSCLC

Now Viewing

EP: 14.Tissue vs Plasma Biopsy After First Disease Progression in EGFR-Mutant NSCLC

EP: 15.Deciding Between a Biomarker-Directed Approach and a Biomarker-Agnostic Approach for Second-Line Treatment of EGFR-Mutant NSCLC

EP: 16.Continuing the Targeted TKI in the Second Line for the Treatment of EGFR-Mutant NSCLC

EP: 17.When to Consider Retreatment With Chemotherapy After FLAURA2 for EGFR-Mutant NSCLC

EP: 18.Patient Case Presentation: A 45-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Liver Metastases

EP: 19.Patient Case Presentation: A 69-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Symptomatic Brain Metastases

This segment addresses the critical decision-making process for tissue vs plasma biopsy strategies when patients with EGFR-mutant metastatic non–small cell lung cancer (mNSCLC) experience disease progression on frontline therapy. The discussion emphasizes the routine use of liquid biopsy (plasma circulating tumor DNA) as the initial approach due to its ease of implementation and rapid technological advancement. Many testing platforms now offer simultaneous minimal residual disease (MRD) assessment alongside mutational analysis, providing comprehensive information about disease status and resistance mechanisms. The integration of circulating tumor DNA technology represents a significant advancement in monitoring treatment response and disease evolution.

The role of MRD testing is highlighted as an emerging tool that may revolutionize treatment decision-making by providing objective measures of treatment response. The technology offers potential for both treatment intensification and de-escalation strategies based on MRD status, with achieving MRD negativity becoming an important therapeutic end point. This approach could fundamentally change how clinicians assess treatment efficacy and make decisions about consolidative therapies, as illustrated by the previous case example where surgical intervention after systemic therapy response might be validated by MRD negativity achievement.

Tissue rebiopsy decisions require careful consideration of clinical circumstances and potential impact on treatment management. While convincing patients to undergo repeat biopsies can be challenging, certain disease characteristics warrant tissue sampling, including progression at multiple sites, unexpectedly rapid progression patterns, or clinical suspicion of transformation or resistance mechanisms when liquid biopsy results are uninformative. However, for patients with oligoprogressive disease suitable for radiation therapy, tissue rebiopsy is typically unnecessary since the management approach (local radiation while continuing systemic therapy) remains unchanged regardless of biopsy results. The decision framework emphasizes practicality and clinical utility, ensuring that invasive procedures are pursued only when results would meaningfully influence treatment decisions.