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 is linked to longer event-free survival, with a pooled HR of 0.22.

• Why it matters: Even with perioperative therapy, resectable NSCLC has a high relapse risk, and clinicians need prespecified biomarkers to better stratify patients’ outcomes.
• What they did: NeoCOAST-2 is a phase 2 randomized platform trial testing perioperative regimens; ctDNA clearance was measured using a tumour-agnostic assay at neoadjuvant Cycle 3 Day 1.
• The result: ctDNA clearance correlated with 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 (EFS HR 0.10; 95% CI 0.02–0.42; P = 0.002).

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