ctDNA-Guided CURB for OPD mNSCLC on TKI (CURB-TKI)

Inclusion Criteria

• •1. Age 18 or older.
• •2. Able to do most daily activities (ECOG 0-2).
• •3. Able and willing to sign an informed consent form to join the study.
• •4. Metastatic non-small cell lung cancer (NSCLC) with either an EGFR mutation or ALK rearrangement confirmed by imaging and biopsy.
• •5. Eligible for second-line therapy or targeted treatment (TKI) if in Group B.
• •6. Willing to give a blood sample for ctDNA analysis.
• •7. No limit to how many metastatic sites, but up to 5 progressive lesions that do not require immediate treatment.
• •8. Prior radiation therapy near progressive lesions is allowed if applicable.
• •9. Cancer lesions must be treatable with specific radiotherapy methods (like SBRT or ablative therapy).
• •10. Oligoprogressive disease is evaluated independently for each lesion using specific criteria.
• •11. Stable brain metastases allowed if asymptomatic and do not require corticosteroids.
• •12. Prior treatment with radiation for oligoprogressive lesions is allowed as long as they remain asymptomatic and re-treatment is possible.
• •13. Prior non-stereotactic radiation for palliative purposes is allowed, and if the lesion later progresses but is still asymptomatic and does not require immediate therapy, it can count towards the 5 oligoprogressive lesions.
• •14. Able and willing to complete quality of life and health utility questionnaires in English, French, or Spanish.
• •15. Accessible for treatment and follow-up.