Liquid Biopsy Implementation for NSCLC: What Can New Brunswick Learn from Ontario’s Experience

Background: In the evolving landscape of precision oncology for non-small cell lung cancer (NSCLC), timely and comprehensive molecular profiling is essential for identifying biomarker-matched therapies that improve outcomes in advanced stages. However, tissue biopsy, the current gold standard, presents challenges including invasiveness, insufficient tissue (in 5–16% of cases), inadequate DNA, and long turnaround times (for example, median 36.5 days in some Ontario centres), all of which may delay or compromise treatment. Liquid biopsy, a minimally invasive technique analyzing circulating tumour DNA (ctDNA) and RNA (cfRNA), offers a promising alternative.

Objective: This review evaluates Ontario’s experience with liquid biopsy implementation in NSCLC as a case study to inform adoption strategies in New Brunswick, where such programs are emerging.

Methods: A targeted policy and literature synthesis was conducted, drawing on publicly available health technology assessments (HTAs), multidisciplinary working group reports, peer-reviewed publications, and international guidelines (ASCO, ESMO, IASLC, and NCCN). Key focus areas included eligibility criteria, diagnostic performance, turnaround time, cost-effectiveness, and integration into public healthcare.

Results: Ontario proposes liquid biopsy as a complementary, not replacement, tool for tissue biopsy. Funding eligibility includes (1) insufficient or failed tissue biopsy; (2) clinically suspected advanced NSCLC where biopsy is not feasible; and (3) high-risk patients likely to deteriorate before tissue results are available. Liquid biopsy offers faster results (7–10 days) compared to tissue (up to 36.5 days), facilitating earlier treatment. Although sensitivity ranges from 63% to 81% (lower for fusions and CNVs), economic modeling suggests that it may reduce downstream costs and improve patient outcomes when used appropriately.

Conclusion: Ontario’s model provides a structured framework for New Brunswick’s implementation. Prioritizing high-need patients, investing in diagnostic infrastructure, and ensuring cost-efficiency can enable broader access to precision therapies while minimizing diagnostic delays.