Combined Biopsy Strategy Identifies More Targets, Improves Survival in Advanced Tumors
Patients with advanced solid tumors lived longer when their treatment was guided by results from both tissue and liquid biopsies, compared with standard-of-care therapy or treatment guided by only one biopsy type, according to results from the phase 2 ROME trial presented at the American Association for Cancer Research Annual Meeting.
The findings highlight the potential of combining tissue and liquid biopsy testing to improve precision oncology and patient survival outcomes, according to presenting authors from the Istituto Dermopatico dell’Immacolata in Rome.
Patients with advanced solid tumors experienced significantly improved survival outcomes with tailored treatment guided by tissue plus liquid biopsies vs. individually, according to results presented by Paolo Marchetti, MD: https://t.co/xhHBybO1Rp #AACR25 @oncologiaroma pic.twitter.com/NxcM4sXRWA
— AACR (@AACR) April 29, 2025
Tissue biopsies involve surgically removing a piece of the tumor for analysis but may miss genetic changes present elsewhere in the body. Liquid biopsies, drawn from a blood sample, offer a less invasive alternative but may not detect mutations from tumors that do not shed many cells into the bloodstream.
Between November 2020 and August 2023, the trial enrolled 1,794 patients with advanced or metastatic solid tumors who had already undergone at least one line of therapy. All participants underwent both tissue and liquid biopsies. A molecular tumor board analyzed results to assess whether actionable mutations appeared in both tests, only one or neither.
Among the 400 patients who had at least one actionable alteration, about half (49.2%) showed the same targetable mutation in both biopsy types. Patients in this category who received matched targeted therapy had significantly better outcomes than those treated with standard therapy.
Patients with mutations found in only one biopsy type showed a less clear benefit from tailored therapy.
Marilyn Bui, MD, PhD
“Using both tissue and liquid biopsies to guide treatment resulted in better outcomes than standard care,” said Marilyn Bui, MD, PhD, scientific director of the Analytic Microscopy Core at Moffitt Cancer Center. “Combined next-generation sequencing offers a more precise way to identify clinically meaningful biomarkers and match patients with the most effective targeted therapies.”
Differences between biopsy results were attributed to factors such as variations in tumor biology between metastatic sites, detection sensitivity and testing failures.
The study’s authors said improving sensitivity in current testing technologies and integrating results from multiple sources could help further refine personalized cancer treatment. Still, they cautioned that the ROME trial had limitations, including the exploratory nature of the analysis, small subgroup sizes, and different timing between tissue and blood sampling.
“These results highlight the importance of a comprehensive molecular approach in precision oncology,” Bui said. “By capturing a fuller picture of the tumor’s genetic landscape, we can offer patients more personalized, and ultimately more successful, treatment options.”
