TEST:

AVENIO Tumor Tissue Targeted Kit

This is the largest cohort-level study in Spain to profile the analyses of biopsy samples of different tumors using NGS in routine clinical practice. Our findings showed that the use of NGS routinely provides good rates of informative results and can improve tumor characterization and identify a greater number of actionable mutations.

Finally, we analyzed the progression-free survival (PFS) and overall survival (OS) of commutated patients vs. non-commutated treated with Osimertinib as a first line treatment and, although it was statistically non-significant due to the small sample size (11 vs 9) and the short follow-up, a very positive trend was seen (log-rank test p = 0.055 and p = 0.136 respectively). With the development of NGS, the presence of other commutations besides EGFR have implications that are still unknown, but it appears that it may cause worse OS and PFS. This should be studied in larger cohorts with longer follow-up.

This mutation is more frequent in early stages, being the most frequent KRAS G12D in metastatic patients. PD-L1 status is similar in all high prevalence mutations.

Plasma-CMP is a reliable tool in the primary diagnostic setting, although it cannot fully replace SoC-TMP. Complementary profiling by combined SoC-TMP and plasma-CMP increased the proportion of patients who are eligible for targeted treatment.

"A repeated tissue biopsy and a ccfDNA analysis were useful in analyzing the mechanisms underlying acquired resistance. A long treatment history of EGFR TKIs may result in a high percentage of EGFR structural change."

Detection of the oncogenic driver and monitoring evolution of resistance prior to PD is possible in a selected group of patients with detectable ctDNA at the start of osimertinib treatment. Sequential ctDNA analysis may guide initiation of additional therapy targeting resistance mechanisms. Future in a large cohort will provide evidence whether ctDNA guided treatment on osimertinib progression has clinical utility.