"Plasma-first" approach for molecular genotyping in non-small cell lung cancer: A narrative review

Molecular genotyping is essential for management of patients newly diagnosed with advanced non-small cell lung cancer (NSCLC). Plasma circulating tumor DNA (ctDNA) testing has emerged as a complement to tumor tissue genotyping for advanced NSCLC, especially when tissue or time are limited. The optimal way to integrate ctDNA testing into the diagnostic algorithm for patients with newly diagnosed NSCLC remains unclear. A "plasma-first" approach, using ctDNA genotyping for patients with suspected or confirmed advanced NSCLC before tissue genotyping, may shorten time to treatment and yield a higher rate of detection of actionable genomic alterations. In this review, we discuss current evidence exploring the "plasma-first" approach.