Personalised medicine, an essential component of modern thoracic oncology, has been evolving continuously ever since the discovery of the epidermal growth factor receptor and its tyrosine kinase inhibitors. Today, screening for driver alterations in patients with advanced lung adenocarcinoma as well as those with squamous cell carcinoma and no/little history of smoking is mandatory. Multiplex molecular platforms are preferred to sequential molecular testing since they are less time- and tissue-consuming. In this review, we present the latest updates on the nine most common actionable driver alterations in nonsmall cell lung cancer. Liquid biopsy, a simple noninvasive technique that uses different analytes, mostly circulating tumour DNA, is an appealing tool that is used in thoracic oncology to identify driver alterations including resistance mutations. Additional roles are being evaluated in clinical trials and include monitoring the response to treatment, screening for lung cancer in high-risk patients and early detection of relapse in the adjuvant setting. In addition, liquid biopsy is being tested in immune-oncology as a prognostic, predictive and pharmacodynamic tool. The major limitation of plasma-based assays remains their low sensitivity when compared to tissue-based assays. Ensuring the clinical validity and utility of liquid biopsy will definitely optimise cancer care.

自从发现表皮生长因子受体及其酪氨酸激酶抑制剂以来，个性化医疗是现代胸部肿瘤学的重要组成部分，一直在不断发展。今天，必须对晚期肺腺癌患者以及鳞状细胞癌患者和无/很少吸烟史的患者进行驱动改变筛查。多重分子平台优于顺序分子测试，因为它们耗时和组织消耗更少。在这篇综述中，我们介绍了非小细胞肺癌中九种最常见的可操作驱动因素改变的最新更新。液体活检，一种简单的无创技术，使用不同的分析物，主要是循环肿瘤 DNA，是一种吸引人的工具，用于胸部肿瘤学，以识别包括耐药突变在内的驱动基因改变。临床试验正在评估其他作用，包括监测对治疗的反应、筛查高危患者的肺癌以及在辅助治疗中早期发现复发。此外，液体活检作为一种预后、预测和药效学工具正在免疫肿瘤学中进行测试。与基于组织的检测相比，基于血浆的检测的主要局限性仍然是灵敏度低。确保液体活检的临床有效性和实用性肯定会优化癌症护理。在辅助环境中筛查高危患者的肺癌和早期发现复发。此外，液体活检作为一种预后、预测和药效学工具正在免疫肿瘤学中进行测试。与基于组织的检测相比，基于血浆的检测的主要局限性仍然是灵敏度低。确保液体活检的临床有效性和实用性肯定会优化癌症护理。在辅助环境中筛查高危患者的肺癌和早期发现复发。此外，液体活检作为一种预后、预测和药效学工具正在免疫肿瘤学中进行测试。与基于组织的检测相比，基于血浆的检测的主要局限性仍然是灵敏度低。确保液体活检的临床有效性和实用性肯定会优化癌症护理。