Dr. Luangyot Thongthieang shared a metastatic NSCLC case (47-year-old female, ECOG 1, stage IV with brain metastasis) to show how serial ctDNA, via the K-TRACK platform, can clarify uncertain imaging findings. Baseline blood-based CGP identified an EGFR exon 19 deletion (E746_A750del) with co-mutations TP53 R213P and ATM R3008C, and a tumor fraction of 6.06%. He noted that this EGFR Ex19del + TP53 + ATM profile indicates higher risk and supports treatment intensification.
Treatment followed a FLAURA2-based regimen (osimertinib plus pemetrexed/carboplatin), resulting in complete intracranial response and partial systemic response. Subsequent imaging showed stable target lesions but a new non-target lesion. Instead of changing therapy immediately, the team used serial ctDNA monitoring to interpret these findings. The tumor fraction dropped from 6.06% to 0.05%, supporting continued treatment. He emphasized a key principle: decisions should integrate clinical status, imaging results, and molecular trends—not rely on imaging alone.
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