A blood test which could help thousands of people receive earlier, more targeted, lung cancer treatments is being trialled by the NHS.

The circulating tumour DNA (ctDNA) test – which will be offered to 10,000 patients by next March – can identify genetic variants in a tumour through a simple blood sample.

Patients that receive CT scan results showing suspected lung cancer will have a small blood sample sent to a genomic laboratory for ctDNA testing, with results returned in around 14 days.

Cancerous tumours often release pieces of DNA into the bloodstream (known as circulating tumour DNA) and these can be sampled using a ctDNA blood test to identify key genetic drivers of tumours.

Currently, tissue biopsies are used to confirm a diagnosis of lung cancer and samples can then be sent for genomic testing – but this new test could provide patients with these results faster, meaning they could start targeted treatment sooner.

The move from NHS England follows a smaller initial pilot which saw more than 2,000 patients referred for the service from 80 trusts across England.

The pilot is now set to be rolled out to provide the test for up to a further 10,000 patients with suspected non-small cell lung cancer by next March – and could involve most trusts across the country.

This is just the latest innovation in cancer care on the NHS – earlier this month, the NHS rolled out a new immunotherapy for hundreds of women with advanced endometrial cancer and, last August, a world-first cancer jab that cuts treatment time by 75% to as little as seven minutes.

Lung cancer is one of the most common cancers, and around 34,000 people are diagnosed with it every year in England. Non-small cell lung cancer is the most common lung cancer, accounting for around 80 to 85% of cases.

Kat Robinson, a 33-year old from Dorset, was diagnosed with stage 4 non-small cell lung cancer in September 2023. Thanks to the ctDNA pilot at Poole Hospital which Kat took part in, clinicians confirmed that her cancer was being driven by two genetic mutations known as ALK fusion and TP53. This enabled them to provide brigatinib, a precision treatment that is highly effective against cancer with changes in the ALK gene.

Kat said: “When I first heard my diagnosis, I spent a lot of time trying to understand if I did it to myself. Having the ctDNA test results back gave me a sense of relief that there was no one to blame, I couldn’t be angry about it.

“The tablets help me keep my cancer in check, they are allowing me to carry on with my day-to-day life. I can do things with my family – I can be a mum to my daughter.”

Peter Johnson, National Clinical Director for Cancer at NHS England, said:

“This new blood test that we have been piloting has the potential to help many more cancer patients access targeted treatments more rapidly on the NHS, to make personalised treatments available sooner, and ensure that people with cancer have the best possible chance of survival.

“The NHS has shown it can lead the way on innovation in cancer diagnosis and treatment, and this pilot is another example of our commitment to getting patients cutting-edge treatments and therapies to improve outcomes, giving people facing lung cancer more precious time with loved ones.”

The NHS England pilot is being managed through the NHS Genomic Medicine Service.

Earlier testing was carried out by Guardant Health and Roche, who have developed liquid biopsy technology. The Royal Marsden NHS Foundation Trust is now working with Guardant Health on what is known as the Marsden360 service.

Professor Dame Sue Hill, Chief Scientific Officer for England, said:

“This pilot is an exciting step in our work to bring more targeted treatments to NHS patients – the testing of thousands of patients with this innovative ctDNA test, is part of our ongoing commitment to deliver a world-leading genomic medicine service and transform the way we diagnose and treat people – often with far greater speed and accuracy.

“This is just the latest example of the NHS collaborating with industry partners and leading the way in genomics by providing the latest, most innovative tests and treatments to help people live longer, healthier lives.”

Professor Sanjay Popat, co-clinical lead of the ctDNA pilot and a Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, said:

“CtDNA liquid biopsies have the potential to transform cancer care for patients, from earlier diagnosis to prognosis and better management of treatments.

“It is fantastic that through collaborating with NHS England we can look to bring cutting-edge genomic testing to patients in the NHS, resulting in many patients receiving targeted treatments rather than standard chemotherapy.

“Our Marsden360 service, established in partnership with Guardant Health, also allows us to significantly increase our capacity for research using ctDNA testing, improving treatment options for patients across the UK.”

Professor Alastair Greystoke, co-clinical lead of the ctDNA pilot and Honorary Medical Oncologist at The Newcastle upon Tyne Hospitals NHS Foundation Trust, said:

“It is fantastic that through collaborations across the NHS Genomic Medicine Service we can look to bring cutting-edge genomic testing to patients in the NHS. This pilot study is already significantly impacting patient journeys across the country, giving them quicker access to precision medicine.”

Dr Michael Hubank, Scientific Lead for the North Thames Genomics Laboratory Hub and Joint Head of Clinical Genomics at The Royal Marsden NHS Foundation Trust, said:

“For many years, research has highlighted the power liquid biopsies, like ctDNA, can have in cancer care and so it is fantastic to see that, through the NHS Genomic Medicine Service, we can begin to integrate them into standard clinical pathways. Advanced genomics testing like this, brings us a step closer to providing precision medicine to patients in the NHS.”

Health Minister, Andrew Stephenson said:

“Lung cancer is one of the deadliest cancers so it’s vital that we can detect it as soon as possible and start targeted treatment.

“The results of this trial so far have shown that we could speed up diagnosis, getting people started on treatments targeted to their specific cancer type sooner. Survival rates are already improving across almost all types of cancer, with cancer being diagnosed at an earlier stage, more often.”

Helmy Eltoukhy, Guardant Health chairman and co-CEO, said:

“Liquid biopsies aren’t just the future of cancer care – they are already being used in the clinic to guide treatment decisions and match patients to potentially life-saving targeted therapies.

“The new national pilot in England offers the exciting opportunity for this new technology to be integrated into routine lung cancer care so that patients get the benefits of an earlier diagnosis and treatment. NHS England and The Royal Marsden have really grasped this opportunity and are leading the world in implementing liquid biopsies – starting with lung cancer – and we are honoured to partner with them in this endeavour.”

Kelly Warrington, Precision Medicine and Genomics lead Roche Products Ltd, said:

“Roche has been delighted to partner with the NHS for the past three years, with our affiliate Foundation Medicine Inc, to deliver ctDNA testing for patients with suspected non-small cell lung cancer. This partnership supports our ambition of ensuring patients with cancer have access to the latest innovation and technology, which drives personalised treatment decisions that enable the best possible outcomes.”

NHS England Friday 22nd March 2024