Early NSCLC at ASCO: Evaluating New Assay & Treatment Patterns

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New ASCO data highlight presurgical ctDNA as a relapse predictor in early NSCLC and show surgery improves survival over radiation among veterans.

A wealth of new data on lung cancer is being presented at the 2025 ASCO Annual Meeting, including several abstracts on early non-small cell lung cancer (eNSCLC).

Presurgical Prognostication

The prospective MUSETALK-Lung01 study evaluated a tumor-naïve circulating tumor DNA (ctDNA) assay in patients with eNSCLC. The researchers enrolled 289 patients with stage I–IIIA NSCLC, collecting pretreatment plasma samples and analyzing cell-free DNA using a blood-based assay that integrates genetic and epigenetic signals.

At the time of analysis, 49% (141/289) of participants had reached the 5-year follow-up, with a median follow-up duration of 59 months. Prognostic analyses focused on relapse-free survival (RFS) and overall survival (OS), stratified by clinical stage and pathological subtype.

Among 179 patients with stage I lung adenocarcinoma (LUAD), ctDNA was detected preoperatively in 20 patients. These patients with ctDNA-positive disease had a 2-year RFS of 70% (95% CI, 46%–88%), compared with 94% (95% CI, 90%–97%) in those with ctDNA-negative disease (log-rank P<0.001). The researchers did not find any similar associations in patients with stage II–IIIA LUAD or non-LUAD NSCLC.

Among patients with stage I LUAD, 11 experienced relapse within two years, with six being ctDNA-positive. In contrast, the researchers found positive ctDNA status in only 1 of 12 patients who relapsed between years 2 and 5, and in 13 of 156 patients who never relapsed (χ² test, P < 0.001).

“These findings indicate that presurgical ctDNA can serve as a prognostic indicator in early-stage NSCLC,” the study authors concluded. “Tumor-naive ctDNA testing may enhance the standard workflow by identifying high-risk patients who could benefit from innovative treatments.”

Treatment Patterns in Veterans

Madison Panell, DO, and colleagues conducted a retrospective study of US veterans with stage I NSCLC to evaluate treatment patterns and survival outcomes.

Using data from the Veterans Affairs Cancer Care Cube (2000–2023), the researchers stratified patients by initial treatment (surgery or radiation therapy) and demographic characteristics, including age, race/ethnicity, sex, ECOG performance status, and toxic exposure history. Kaplan-Meier survival analysis, Cox regression, and logistic modeling were used to assess survival and predictors of treatment selection.

Surgical resection was associated with superior 5-year survival rates across all age groups: 41.77–54.32% for those aged 40–59 and 42.32% for those over 70, compared with 0–24.68% for those treated with radiation therapy.

Treatment utilization by race was similar; however, survival rates varied. Asian patients had the highest 5-year survival following surgery (60.87%), while Native Hawaiian/Pacific Islander (NHPI) patients had the lowest survival for both surgery and radiation.

Women were more likely to receive surgery (71.79%) and had better outcomes than men.

Across all ECOG scores, surgery was the preferred approach, though higher ECOG scores correlated with lower long-term survival. Veterans with Agent Orange or asbestos exposure had the best surgical outcomes, while radiation therapy was not associated with a durable benefit regardless of exposure type.

“Surgery consistently yields better survival outcomes than radiation therapy for veterans with early-stage NSCLC, even among subgroups with higher comorbidity burdens,” Dr. Panell and colleagues concluded. “Demographic and exposure-related disparities highlight the need for tailored interventions to optimize care. These findings inform clinical decision-making and emphasize the importance of equitable access to curative treatments in this vulnerable population.”