Liquid and Tissue Biopsy Can Be Complementary in NSCLC, Says Dr Mark Socinski

Mark A. Socinski, MD, executive director of the AdventHealth Cancer Institute, shares his insight on liquid- and tissue-based biopsies and their clinical utility in non–small cell lung cancer (NSCLC).

Transcript

What are your thoughts on tissue- vs blood-based biomarker testing and where that area is heading in NSCLC?

Historically, the standard has kind of been tissue-based testing, although I do not think that's the current standard. I think that we have demonstrated the clinical utility of plasma-based testing, which is so much more efficient with regard to next-generation sequencing, because all you have to do is draw the patient's blood. We do it right in the office at the time of their visit, for the first time. And I think we've demonstrated that tissue in plasma-based testing is really complementary. Most of the time, let's say, 80% of the time, you'll find the same thing in tissue that you'll find in blood, but there's about a 20% chance that you'll find something in tissue you don't find in blood, or vice versa, you find something in blood you don't find in tissue.

The other issue with tissue in non–small-cell lung cancer is it's a scarce commodity. Often, our biopsies are not very robust. We actually reviewed a case this morning in our tumor board in which the sample from the tissue biopsy was insufficient for molecular testing. So that's one example. And that's not a terribly uncommon situation in non–small-cell lung cancer because of the nature of the population. And you don't always get a great biopsy. So that's where plasma-based testing can be complementary and should be considered a standard, as well as in conjunction with tissue.

I mentioned clinical utility—I think it's important for people to be aware of the NILE trial where they really looked at the addition of plasma-based testing to tissue-based testing, and it did increase the yield of identifying genomic alterations that had FDA-approved targeted therapies associated with them. So as a part of practice, I find it completely useful. I tend to do both tissue and blood at the time of diagnosis because I think one of the greatest things an oncologist can do for a lung cancer patient is find the genomic driver, because we have these wonderful targeted therapies that are highly effective. And one can't use them unless you make the genomic diagnosis.