Enhanced Patient Outcomes Through Combined Tissue and Liquid Biopsy-Guided Personalized Treatment

Recent advancements in precision oncology demonstrate that utilizing both tissue and liquid biopsies to guide personalized treatment can significantly improve outcomes for patients with advanced solid tumors. A phase II multicenter study, the ROME trial, presented at the AACR Annual Meeting 2025, revealed that patients whose tumors exhibited the same genomic alterations in both biopsy types experienced notably longer survival and better disease control than those receiving standard therapies or those with discordant biopsy results.

Genomic profiling, essential to precision medicine, involves detecting tumor-specific genetic changes targeted by therapies. Conventionally, tests use tissue samples obtained invasively or blood samples via liquid biopsies. Each method has limitations; tissue biopsies may miss heterogeneity within the tumor due to sampling from a single region, while liquid biopsies might not detect mutations if tumor cells do not shed DNA into circulation.

The ROME trial enrolled 1,794 adults with metastatic solid tumors who provided both liquid and tissue samples for genomic analysis. The study assessed the concordance of detected alterations and their implications for targeted therapy. Results found that in nearly half of the cases, both biopsy methods identified the same actionable alterations, enabling tailored treatment approaches.

Patients with concordant results and receiving personalized therapy showed significantly improved median overall survival—11.05 months versus 7.7 months with standard care—and reduced risk of death. Progression-free survival was also longer, emphasizing the benefit of combined profiling. Conversely, discordant cases showed smaller or no survival advantage, highlighting the importance of comprehensive molecular assessment.

Further analysis indicated that addressing discordance by improving profiling techniques and understanding tumor heterogeneity could refine personalized strategies. Factors such as mutations in specific pathways (e.g., PI3K/PTEN/AKT/mTOR and ERBB2) and tumor mutational burden influenced discordance rates. Ongoing validation aims to optimize the integration of tissue and liquid biopsies, ultimately enhancing treatment precision and patient outcomes.

Limitations include the exploratory nature of the study and variability in sample timing. Nonetheless, these findings underscore the potential of dual-biopsy approaches to better select targeted therapies and improve prognosis for patients with complex cancers.