Personalizing ctDNA Monitoring Strategies for NSCLC With MET Mutation: Yang Xia, MD, PhD

Circulating tumor DNA (ctDNA) has promise as a therapeutic monitoring tool, but personalization by patient is important, and there remain challenges around turnaround time, cost and reimbursement, and integrating the process into the workflow, said Yang Xia, MD, PhD, of the Department of Respiratory Medicine at the Second Affiliated Hospital Zhejiang University School of Medicine. Xia presented the abstract “Comparative Analysis of Circulating Tumor DNA Monitoring Strategies in Advanced NSCLC With MET Exon 14 Skipping Treated With Ensartinib” at the 2025 World Lung Cancer Conference, held September 6-9, 2025, in Barcelona, Spain.

The abstract reviewed a translational biomarker study based on the main findings of the EMBRACE trial. Xia and his colleagues evaluated ctDNA for monitoring MET exon 14 skipping mutation in non–small cell lung cancer.

The transcript has been edited for clarity; captions are auto-generated.

Transcript

How should a provider, in a real-world clinical setting, decide which ctDNA monitoring strategy to use for a patient? Is it a "one-size-fits-all" approach, or does it need to be personalized?

I think it should be personalized. We recommend starting with specific testing for early response assessments. If resistance is suspected, it’s important [to conduct] canonical or permutation panels to identify the resistant mechanism. Not all patients need broad testing; base [the testing] on clinical context and resource availability.

What are the key logistical challenges of implementing routine serial ctDNA testing in a cancer center or community oncology practice?

I think the key challenges include standardization. Now there is lack of consensus on optimal panel timing and interpretation. The second [challenge] is turnaround time. In China, it usually takes 1 week, but in the United States, it may [take up to] 1 month. The third [challenge] is the cost and the reimbursements. The coverage for serous testing is not universal. The last [challenge] is the integration to the workflow, coordinating blood draw processing and data analysis, something like that.