ctDNA clearance and outcomes for resectable lung cancer from NeoCOAST-2.

In resectable stage IIA–IIIB NSCLC in NeoCOAST-2, ctDNA clearance at neoadjuvant Cycle 3 Day 1 was highest with Dato-DXd (72.5%).

• Why it matters: Relapse risk remains high after perioperative therapy, and clinicians need prespecified biomarkers to better stratify patients’ event-free survival risk.
• What they did: NeoCOAST-2 is a phase 2 randomized platform trial; using a tumour-agnostic ctDNA assay, clearance at Cycle 3 Day 1 was measured across Arms 1 (50.9%), 2 (54.5%), and 4 (72.5%).
• The result: ctDNA clearance was linked to prolonged EFS versus non-clearance (pooled HR 0.22; 95% CI 0.11–0.45; P = 0.0000443), and patients with both clearance and pCR had favourable EFS (HR 0.10; 95% CI 0.02–0.42; P = 0.002).