Improving lung cancer management through pre-visit liquid biopsy: The LUNG-FAST pilot study.

478 Background: Timely molecular profiling is essential for the effective systemic management of non-small cell lung cancer. This pilot study aimed to optimize the molecular profiling process by having a thoracic oncology intake nurse navigator (INN) identify patients with lung cancer eligible for liquid biopsy prior to their new patient visit. Methods: The Liquid biopsy for Urgent Neoplastic Genomic profiling – Focused Accelerated Stratification and Testing ( LUNG-FAST) pilot enrolled 64 patients from October 1, 2024 through January 31, 2025. INNs identified eligible patients based on clinical criteria and patient proximity to MD Anderson Cancer Center (MDA). INNs requested primary oncology teams to place orders in advance of the new patient consultation, either for an MDA blood draw (for MDA liquid biopsy) or an at-home blood draw (for CARIS liquid biopsy). Key outcomes included operational aspects of advanced liquid biopsy orders, turnaround time for results, and the impact of molecular profiling on treatment and patient management. Results: 64 patients participated, with 60 (93.7%) identified by INNs. Liquid biopsy orders were placed for 58 patients (90.6%), and 62% of these orders were placed before the new patient visit. 62% had an established diagnosis of non-small cell lung cancer and no mention of molecular profiling in their intake review. The average turnaround time for CARIS liquid biopsy results, from at-home blood draw to result delivery, was 8.45 days (range: 6–11 days), and 12.5 days (range: 7–25 days) for MDA onsite blood draw. Molecular profiling results were delivered before the new patient visit for 13.7% of patients. CARIS results were available an average 2.41 days after the new visit (range: -25-12 days), while MDA results averaged 11.0 days (range: -4- 35 days). 56.8% of patients underwent both liquid and tissue profiling. Clinically relevant or actionable alterations, defined as genetic changes associated with a specific standard-of-care drug or trial option, were identified in 46.5% of cases using one or both testing methods. Liquid biopsy alone identified actionable alterations in 22.4%, while tissue profiling revealed alterations not detected by liquid biopsy in 24.1%, highlighting its complementary role. The average time from result delivery to systemic therapy initiation was 17 days (range: -2-71 days). Conclusions: This pilot study shows that molecular profiling with liquid biopsy before the initial visit is feasible and can streamline lung cancer care. Most patients were successfully identified by INNs, highlighting their role in patient selection. Liquid biopsy was often ordered before the first visit and detected clinically relevant alterations in 22.4% of cases. These findings support using liquid biopsy in lung cancer management and emphasize the need to improve profiling speed. Larger studies are needed to optimize turnaround and outcomes.