Burning Rock Biotech Limited (“Burning Rock”) and its clinical collaborators presented three studies at the 2026 World Conference on Lung Cancer (WCLC 2026), addressing key clinical questions in small invasive lung adenocarcinoma (LUAD), response prediction for neoadjuvant immunochemotherapy in lung squamous cell carcinoma (LUSC), and pleural effusion-based molecular testing in advanced lung cancer.
The studies leveraged OncoScreen® LungCore, OncoScreen® Plus、OncoScreen® Capture-WTS and OncoCompass® Target, respectively, exploring their applications across disease biology, treatment stratification and specimen selection in precision lung cancer care.
OncoScreen® LungCore | Distinct Molecular Features Suggest a “Born-to-be-Malignant” Trajectory in Small Invasive LUAD
Collaborating Institution: Shanghai Chest Hospital
Small invasive lung adenocarcinomas (sIACs; ≤1 cm) can exhibit aggressive behavior despite their small size. To investigate their biological characteristics, the study used OncoScreen® LungCore for tissue-based genomic profiling, together with transcriptomic analysis, to compare sIACs with pre-invasive/minimally invasive lesions. The genomic cohort included 700 samples, with an additional 28 samples analyzed in the transcriptomic cohort.
Results: Visceral pleural invasion and N1/N2 lymph node metastasis occurred exclusively in sIACs. Compared with small pre-invasive/minimally invasive lesions (sPMs), sIACs showed higher frequencies of EGFR (75.2% vs. 46.5%), TP53 (24.8% vs. 2.7%) and EGFR/TP53 co-alterations (24.1% vs. 5.1%), along with broader oncogenic pathway involvement. Transcriptomic analysis further revealed higher chromosomal instability, proliferation and EMT signatures, together with cell-cycle and metabolic pathway activation and immune microenvironment remodeling.
Key Finding:
The findings suggest that sIACs may follow a distinct “born-to-be-malignant” evolutionary trajectory rather than conventional linear progression, providing new molecular insights into the biological heterogeneity and risk stratification of small LUADs.
OncoScreen® Plus & OncoScreen® Capture-WTS | Multi-omics Model Helps Identify LUSC Patients Unlikely to Achieve pCR After Neoadjuvant Immunochemotherapy
Collaborating Institution: Shanghai Chest Hospital
Response to neoadjuvant immunochemotherapy (nICT) remains heterogeneous in patients with locally advanced resectable LUSC, while existing biomarkers such as PD-L1 and TMB have limited predictive performance. Using OncoScreen® Plus、OncoScreen® Capture-WTS and other multi-omics approaches, the study analyzed 116 patients receiving nICT, with external validation in 26 independent patients.
Results: High PD-L1 expression and NFE2L2/KEAP1 mutation status were independently associated with pCR, while ecDNA positivity was associated with a higher pCR rate among patients with high PD-L1 expression. An XGBoost model integrating TMB, wGII, age, PD-L1 and NFE2L2/KEAP1 mutation status achieved an AUC of 0.72 and, in external validation, 88.5% overall accuracy with 100% identification of non-pCR patients. Model-predicted response groups also showed clearer DFS separation than actual pathological response groups.
Key Finding:
Multi-omics integration may help identify patients unlikely to achieve pCR before treatment, supporting more precise pretreatment stratification for neoadjuvant therapy in LUSC.
OncoCompass® Target | Pleural Effusion Shows Potential as an Alternative Molecular Testing Specimen in Advanced Lung Cancer
Collaborating Institutions: Tianjin Chest Hospital and The Fourth Hospital of Hebei Medical University
When sufficient tumor tissue is unavailable, alternative specimens are needed for molecular testing in advanced lung cancer. Using OncoCompass® Target, this multicenter real-world study evaluated pleural effusion (PE), tissue and plasma samples from 355 patients with stage III–IV lung cancer across three independent cohorts.
Results: Cytology-positive PE showed high genomic concordance with matched tissue, including mutation profiles, driver alterations and Tier 1 variants. Even cytology-negative PE achieved 80.6% overall variant positivity and 69.4% Tier 1 variant positivity. PE-based and tissue-based testing showed comparable PFS and best overall response, while PE demonstrated higher molecular detection efficiency than plasma, particularly in patients with intrathoracic metastases.
Key Finding:
PE may serve as an alternative or complementary specimen when tissue is insufficient, with molecular information obtainable even from some cytology-negative samples, expanding molecular testing options for patients with advanced lung cancer.
Across disease biology, treatment stratification and specimen selection, the three studies highlight the applications of Burning Rock’s precision oncology solutions across diverse lung cancer research settings. Burning Rock will continue to work with clinical partners to advance precision oncology research and generate evidence supporting precision cancer care.
