The De-Centralization Perspective for Liquid Biopsy Use in Thoracic Pathology The Way to Go

The liquid biopsy (LBx) concept in thoracic oncology has optimized treatment decision-making for patients with advanced/metastatic non-small cell lung cancer (NSCLC). The clinical practice of LBx in thoracic oncology is based on international guidelines. However, aside from the recommendations for adoption of LBx in daily clinical practice for late-stage NSCLC, other indications evaluate the role of LBx in clinical trials, particularly for early stage NSCLC. Transferring LBx into routine practice requires robust data from clinical research programs that are able to sustain the novel indications of LBx. Equity of access to treatment is linked to access to molecular testing for thoracic malignancies. In this context, widespread dissemination of molecular testing, avoiding centralization to commercially available platforms or to unique national academic institutions, becomes a major component of the current strategy for lung cancer care. Therefore, de-centralized LBx in thoracic oncology is the best approach to democratize molecular testing, optimizing access to personalized therapeutic options for lung cancer patients. LBx de-centralization needs to be perfectly mastered using a high quality approach that gives specific and sensitive results. However, several challenges significantly affect this approach, such as the lack of harmonized technical procedures, pre-analytical challenges and issues in interpreting the molecular records, which can imped significantly the widespread practice of LBx. Our aim was to investigate the interest in and advantages of LBx de-centralization in thoracic oncology. The bottlenecks of this strategy that aim to fill the gaps toward widespread integration of LBx into the daily life of health care systems for lung cancer patients will be discussed.