Lung cancer in practice: When data meets decision‑making
Assoc. Prof. Vu Le Thuong (University of Medicine and Pharmacy Hospital at Ho Chi Minh City – UMP, Vietnam) illustrated the practical application of comprehensive profiling through a lung cancer case. Effective precision therapy requires both breadth of testing to identify actionable targets and depth of monitoring to detect meaningful change over time. In the presented case, combined tissue comprehensive genomic-transcriptomic profiling (CGTP) and plasma profiling and ctDNA analysis using the K-4CARE platform guided both the initial treatment plan and follow-up strategy. The initial baseline testing identified an EGFR-sensitizing mutation in the tumor, along with ctDNA co-alterations including TP53. Together, these findings helped refine prognosis and determine surveillance intensity.
The clearest clinical value emerged during serial monitoring. While the patient was receiving Osimertinib, both imaging and ctDNA showed response, including a marked decline in ctDNA levels. Later, ctDNA detected early resistance signals before definite clinical or radiographic progression, demonstrating how molecular changes can precede imaging findings. As Dr. Vu noted, “This underscores the unique value of ctDNA in tracking disease dynamics—capturing both quantity (tumor burden changes) and quality (emergence of resistance mutations).” While current guidelines do not yet recommend switching therapy based on ctDNA progression alone, he highlighted its practical role in enabling closer monitoring and prompting timely re-biopsy. In this patient repeat biopsy helped guide clinical trial enrollment and provided additional benefit.
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