National ctDNA Lung Cancer Pilot Update" (47 characters)
Update on the National ctDNA Lung Cancer Pilot Project, including treatment decisions, sample statistics, and experiences at South West trusts. Insights into sample usage, platform preferences, patient demographics, and routes to histological diagnosis. The pilot aims to enhance patient care and treatment outcomes for NSCLC. (291 characters)
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National ctDNA Lung Cancer Pilot Update Louise Medley Consultant Medical Oncologist, Torbay and South Devon NHS Trust Cancer Lead, South West Genomic Laboratory Hub SWAG Lung CAG 14th May 2024
NHSE ctDNA NSCLC Pilot Project Patient Treatment decision Treatment Time Critical: Referral to Treatment Standard of Care 700 Samples 1800 Samples 10,000 Samples 100 125 Phase 1 Phase 2 Phase 3 31st December 2023 September 2022 1st July 2023 January December 2024 2025 April 2024 SW GMSA Genomics Event 23rd January 2024 SW GMSA Genomics Event 23rd January 2024
NHSE ctDNA Pilot Project: SW GLH Experience SW GLH PHASE 2 PILOT: Usage of Allocated Samples (*Jan 2024) 25 Good uptake of ctDNA use in SW GMSA 20 National Picture: % Usage of Allocated Samples (Jan 2024) 15 73% 16 5 80 67 64 70 58 19 23 60 43 10 50 14 8 40 28 25 30 1 11 20 10 5 10 6 6 0 5 2 2 NT SE NW NE&Y East SW C&S 0 GH NBT RCH RDUH RUHB Som T Som Y TSD UHBW UHP AVAILABLE USED Good experience of using ctDNA across majority of SW Trusts SW GMSA Genomics Event 23rd January 2024
National ctDNA Lung Cancer Pilot Experience at One Trust in SW GLH Population 290,000
51 Samples Taken (unselected population) Previous Cancer History Previous Cancer History ctDNA Platform Used ctDNA Platform Used Referral Route Referral Route 12 12 16 16 21 21 23 23 30 30 39 39 11 11 Yes Yes No No Roche Platform Roche Platform RMH Platform RMH Platform 2WW 2WW ED ED Other Other
Females = Males Smoking Status Smoking Status Performance Status Performance Status Radiological Stage Radiological Stage 3 3 5 5 7 7 9 9 16 16 22 22 7 7 33 33 12 12 23 23 Current Smoker Current Smoker Never Smoker Never Smoker Ex Smoker Ex Smoker III III IV IV Other Other 0 0 1 1 2 2 3 3
Routes To Histological Diagnosis (57% Radiological Guided) 8 8 12 12 CT Guided Biopsy 1 1 USS Guided Biopsy Bronchoscopy 7 7 VATS Other 17 17
Histological Diagnosis (67% Primary Lung Cancer, 61% NSCLC) 1 11 11 1 4 4 4 4 NSCLC NSCLC 4 4 2 2 Small Cell Small Cell 1 1 2 2 Breast Cancer Breast Cancer 2 2 Mesothelioma Mesothelioma 23 23 31 31 Carcinoid/NET Carcinoid/NET Melanoma Melanoma Adenocarcinoma Adenocarcinoma NOS NOS Squamous Cell Squamous Cell
Tier 1 Variant Detection (25% samples) 2 2 EGFR EGFR 4 4 KRAS G12C KRAS G12C 2 2 ALK ALK Met exon 14 Met exon 14 Skipping Skipping 5 5
Tier 1 Variant Detection (25% samples) VARIANT EGFRL858R EGFR Exon 19 del EGFRL858R EGFR Exon 20ins ALK ALK KRAS G12C KRAS G12C KRAS G12C KRAS G12C KRAS G12C MET Exon 14 Skipping MET Exon 14 Skipping 1st LINE TREATMENT Moved from area Paloma 2 Clinical Trial* May 2023 Non Paloma 2 Clinical Trial*. June 2023 Non Paloma 2 Clinical Trial**. Nov 2023 Alectinib June 2023 Ex Alectinib Oct 2023 BSC BSC Chemotherapy ChemoRT Colon cancer on histology Tepotinib Aug 2023 Ex Tepotinib Jan 2024 Ex SMOKING STATUS Ex HISTOLOGY Adenocarcinoma Adenocarcinoma Adenocarcinoma Adenocarcinoma Adenocarcinoma NSCLC NOS Adenocarcinoma Adenocarcinoma Adenocarcinoma Adenocarcinoma n/a Ex Current Current Ex Current Ex N/A Squamous Adenocarcinoma Paloma 2 Clinical Trial Arm * Lazertinib & Amivantimab ** Carbo/Pemetrexed & Amivantimab
Time Critical: Can ctDNA Improve Referral to Treatment?* Patient with CT scan showing Inoperable lung cancer Access to timely: image guided biopsy, Bronchoscopy, EBUS etc Patient with CT scan showing Inoperable lung cancer Blood for ctDNA Decision to Treat Decision to Treat Tissue for Histology 28 days 42 days Report to MDM Processed at GLH Report to MDM Processed 12 days 15 days SW GMSA Genomics Event 23rd January 2024 * Data from Torbay and South Devon NHS Trust ctDNA Pilot
BENEFITS but only if taken as early as possible in pathway AND clinicians confident to act on ctDNA report Reduction in time to treatment Gain further experience with genomic signatures within lung cancer Identify barriers early (and requirements for investment) prior to SOC implementation Earlier identification of Clinical Trial opportunities for patients What Have We Learnt? Requires genomic conversation to be embedded within whole MDM CHALLENGES Process required at start of pathway BUT the Report required by end of pathway Trained Staff to Take Samples: Can routine Phelbotomy service manage this? Tracking of Samples (Samples do not currently flow through trust Laboratory systems) Report Integration into patient notes Interpretation of results THANK YOU to all Sites and Patients for Participating in the ctDNA Transformation Project
PHASE 3 PHASE 3 Business as Usual no data collection required 100 sample kits ordered by SW from RMH since 1/4/24 29 samples received (21 reported) Average TAT (lab) 11 days BTOG effect seen on Friday with increase number of tests received at RMH! Will ctDNA replace tissue NGS for some for all? What about ctDNA testing at SWGLH? SW Lung GTAB to start very soon (Fridays 2-3pm) Where Next?
Questions? GTAB louise.medley@nhs.net Laura.Yarram-Smith@nbt.nhs.uk ruth.cleaver@nhs.net
