Role of liquid biopsy for thoracic cancers immunotherapy

Our plain-English summary of Role of liquid biopsy for thoracic cancers immunotherapy, by R. Di Liello, F. Cimmino, S. Simón, et al (Exploration of Targeted Anti-tumor Therapy, 2020).

The study

• Authors: R. Di Liello, F. Cimmino, S. Simón, E.F. Giunta, V. De Falco, P. Martín-Martorell
• Journal: Exploration of Targeted Anti-tumor Therapy
• Published: 2020;1(3):183-199
• Type of article: Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Immunotherapy has shifted the therapeutic landscape in thoracic cancers. However, assessment of biomarkers for patient selection and disease monitoring remain challenging, especially considering the lack of tissue sample availability for clinical and research purposes. In this scenario, liquid biopsy (LB), defined as the study and characterization of biomarkers in body fluids, represents a useful alternative strategy. In other malignancies such as colorectal cancer, breast cancer or melanoma, the potential of LB has been more extensively explored for monitoring minimal residual disease or response to treatment, and to investigate mechanisms of resistance to targeted agents. Even if various experiences have already been published about the applications of LB in immunotherapy in thoracic cancers, the standardization of methodology and assessment of its clinical utility is still pending. In this review, the authors will focus on the applications of LB in immunotherapy in non-small cell lung cancer, small cell lung cancer, and malignant pleural mesothelioma, describing available data and future perspectives.

© The Author(s) 2020.

In plain English

This article was a review, not an original study, and did not study asbestos exposure. The authors described published research on liquid biopsy, meaning testing of blood or other body fluids for markers shed by tumors, in patients with thoracic cancers treated with immunotherapy drugs called immune checkpoint inhibitors. They covered non-small cell lung cancer, small cell lung cancer and malignant pleural mesothelioma. Most of the article dealt with non-small cell lung cancer: circulating tumor cells and tumor DNA, a blood-based measure of tumor mutations, and soluble PD-L1. The authors judged results on PD-L1-positive circulating tumor cells as not yet definitive. For non-small cell lung cancer, they reported that tumor mutational burden measured in blood and in tumor tissue correlated positively but modestly in the POPLAR/OAK and MYSTIC trials. For malignant pleural mesothelioma, they wrote that liquid biopsy had been explored for diagnosis and prognosis. To their knowledge, however, no data had been published on liquid biopsy in mesothelioma patients treated with immunotherapy. The authors concluded that liquid biopsy needed expanding and validating in all three cancers.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published studies on liquid biopsy in immunotherapy for thoracic cancers
• Who was studied: No new patients were studied; the review covered published research on patients with non-small cell lung cancer, small cell lung cancer and malignant pleural mesothelioma
• Exposure: No asbestos or fiber exposure was studied. The subject was liquid biopsy markers (circulating tumor cells, circulating tumor DNA and RNA, extracellular vesicles, soluble PD-L1, blood tumor mutational burden) in patients receiving immune checkpoint inhibitors
• Main results:
  • For malignant pleural mesothelioma, the authors reported that, to their knowledge, no data had been published on liquid biopsy in patients treated with immunotherapy
  • In malignant pleural mesothelioma, the authors described liquid biopsy and circulating biomarkers (from blood and also pleural effusion samples) as explored for disease mechanisms, diagnosis and prognosis. These studies more often used circulating proteins, microRNAs or inflammatory and angiogenic factors than tumor DNA
  • The authors judged the reviewed evidence on PD-L1-positive circulating tumor cells as not definitive for predicting immunotherapy benefit in non-small cell lung cancer
  • In non-small cell lung cancer studies, the correlation between blood-based and tissue-based tumor mutational burden was described as positive but generally modest. The Spearman's correlation coefficient was 0.64 (95% CI 0.56 to 0.71) in POPLAR/OAK and 0.6 (no CI given) in MYSTIC
  • In small cell lung cancer, the authors reported that an exploratory blood tumor mutational burden analysis of 351 patients in the IMpower133 trial showed no correlation with clinical benefit. Tissue tumor mutational burden was not analyzed in that cohort
• The authors' conclusion: The authors concluded that liquid biopsy is a promising tool, but its use needs to be expanded and validated in non-small cell lung cancer, small cell lung cancer and malignant pleural mesothelioma
• Limitations the authors state:
  • The authors stated that the studies they reviewed differed in sample timing and analysis platforms, which makes their results hard to compare
  • The authors stated that many earlier studies had few patients or were post-hoc analyses of trials not designed to study liquid biopsy

Topics

Medical terms in this study, explained in our Lexicon: Liquid Biopsy, Immunotherapy, Biomarker, Colorectal Cancer, Non-Small Cell Lung Cancer, Small Cell Lung Cancer, Pleural Mesothelioma.

Related studies

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• Urinary Metabolite Diagnostic and Prognostic Liquid Biopsy Biomarkers of Lung Cancer in Nonsmokers and Tobacco Smokers — B. Dalal, T. Tada, et al. (2024)
• Liquid biopsy perspectives in pleomorphic carcinoma of the lung: case report — T. Rossi, M. Cortesi, et al. (2025)
• Direct comparison of liquid-based and smear-based cytology with and without rapid on-site evaluation for fine needle aspirates of thoracic tumors — A. Mfokazi, C.A. Wright, et al. (2016)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)

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