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Minimal Residual Disease Enhances Prognostic Stratification beyond Pathologic Response in Resectable Non-Small Cell

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Minimal residual disease (MRD) detection after surgery improves prognostic accuracy for resectable non-small cell lung cancer (NSCLC) treated with perioperative chemoimmunotherapy. MRD-negative status indicates favorable survival, even in patients without pathological complete response.

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Area of Science:

  • Oncology
  • Translational Research
  • Molecular Diagnostics

Background:

  • Perioperative chemoimmunotherapy is standard for resectable non-small cell lung cancer (NSCLC).
  • Pathological complete response (pCR) predicts survival, but some non-pCR patients achieve long-term outcomes.
  • Minimal residual disease (MRD) assessment may offer refined prognostic insights.

Purpose of the Study:

  • To evaluate the added prognostic value of minimal residual disease (MRD) in patients with resectable NSCLC.
  • To determine if MRD status refines prognostication beyond pathological complete response (pCR).

Main Methods:

  • MRD was assessed using the Guardant Reveal assay in 60 NSCLC patients from the NADIM II trial.
  • Patients received neoadjuvant nivolumab plus chemotherapy or chemotherapy alone, followed by surgery.
  • Adjuvant nivolumab was administered to experimental arm patients with R0 resection.

Main Results:

  • MRD was detected in 9.6% of patients.
  • Post-operative or during-treatment MRD was associated with inferior event-free survival (EFS) and overall survival (OS).
  • MRD negativity at two time points predicted survival and was associated with significantly lower relapse rates, even among non-pCR patients.

Conclusions:

  • MRD assessment can enhance prognostic stratification in resectable NSCLC.
  • MRD provides valuable prognostic information beyond pCR in patients undergoing perioperative chemoimmunotherapy.
  • MRD-negative status is a strong indicator of favorable outcomes.