A groundbreaking study reveals that patients with advanced solid tumors demonstrate significantly better survival rates when treated with personalized therapies based on consistent genomic findings from both tissue and liquid biopsies. This finding emerged from the phase II, multicenter ROME trial, showcased at the American Association for Cancer Research Annual Meeting 2025. The trial underscores the importance of utilizing combined biopsy techniques to enhance precision oncology treatments.

Genomic profiling plays a crucial role in precision oncology by identifying specific genetic mutations within tumors that can be targeted therapeutically. While blood or tissue samples can both undergo testing, the clinical preference between these methods remains unclear. Paolo Marchetti, MD, scientific director at IDI-IRCCS in Rome, Italy, highlighted that tissue biopsies, though invasive, offer direct access to tumor samples but may miss mutations elsewhere in the tumor. Conversely, liquid biopsies, less invasive, might fail to detect mutations from tumors not shedding sufficient cells into the bloodstream. These differences often lead to inconsistent results, complicating treatment decisions.

The ROME trial enrolled 1,794 adult patients with advanced or metastatic solid tumors undergoing their second or third line of treatment between November 2020 and August 2023. Each participant provided samples for both liquid and tissue biopsies. Next-generation sequencing was conducted, and the results were evaluated by a molecular tumor board focusing on actionable alterations. Among 400 patients identified with targetable mutations, concordant findings between both biopsy types were observed in nearly half the cases (197 patients). Tailored therapy in this group showed superior outcomes compared to standard care, with median overall survival increasing from 7.7 to 11.05 months and progression-free survival improving from 2.8 to 4.93 months. Discordant cases, attributed primarily to detection discrepancies, high mutational burdens, and test failures, emphasized the need for refined strategies integrating multiple molecular profiling techniques.

Precision oncology holds immense promise for advancing cancer treatments. By addressing inconsistencies in biopsy results and leveraging the strengths of both biopsy modalities, researchers aim to refine diagnostic pathways and enhance clinical outcomes for patients with advanced cancers. As demonstrated by the ROME trial, adopting a combined approach could optimize patient selection for tailored therapies, leading to improved survival rates and quality of life. Future studies incorporating serial integrated profiling will further validate these findings, paving the way for more effective precision medicine strategies.