Protocol for Chinese lung cancer evolution and microenvironment tracking under therapy study.

[BACKGROUND AND OBJECTIVES] Recent molecular landscape studies characterizing lung cancer mostly utilize single tumor regions, ignoring tumor heterogeneity and evolutionary patterns. To address this issue, the TRAcking NSCLC Evolution through therapy (TRACERx) Consortium established a multiregion sampling of Western lung cancer to investigate its longitudinal evolutionary dynamics. Due to ancestral differences, there are still major gaps in understanding oriental lung cancer.

[METHODS] We have established a prospective cohort of patients with non-small cell lung cancer (NSCLC) named Chinese lung cancer evolution and microenvironment tracking under therapy (CLEVER) study.

[DISCUSSION] By acquiring comprehensive genetic variation data and clonal events from multiple regions of the tumor, we aim to decipher the molecular evolution code of Chinese lung cancer. The analysis of cell composition and spatial structure further characterizes the remodeling effects of tumor evolution and neoadjuvant therapy on the tumor microenvironment, helping to identify important markers that influence treatment effectiveness and recurrence. By monitoring mutations using a personalized minimal residual disease (MRD) panel from tumors at baseline, we can trace evolutionary significance and clonality, aiding in therapy decisionmaking. The CLEVER study significantly contributes to the development of personalized treatment strategies for lung cancer patients, enhancing outcomes and tailoring interventions to individual patient profiles.