The ASPiRATION-2 Liquid (ASPi-2L) program is a landmark national initiative aiming to change how lung cancer is diagnosed, monitored, and treated across Australia. Led by Prof Ben Solomon, Prof Nick Pavlakis, and TOGA, this innovative study builds on the success of the original ASPiRATION trial, which delivered nationwide access to comprehensive tumour-based genomic testing for people with advanced lung cancer. The ASPi-2L program, supported through a successful $14.7 MRFF Frontier Health and Medical Research Grant, will establish a national framework for delivering liquid biopsy testing, focused on providing access to people with metastatic non-small cell lung cancer (mNSCLC) after their cancer progresses on targeted therapy. Through the delivery of non-invasive liquid biopsy testing, the clinical study aims to help shape treatment decisions and enable personalised treatment based on the tumour’s changing molecular profile.
Click here for remote referral information and links, or contact the ASPi-2L study team at info.aspiration2@sydney.edu.au or call 02 9351 2409 for more information.
Why is ASPiRATION 2L important for oncogene-driven lung cancer?
In oncogene-driven mNSCLC, first-line targeted therapies such as tyrosine kinase inhibitors (TKIs) can control cancer for many months or even years. However, the cancer may eventually progress despite treatment and when this happens, it often leaves patients and clinicians with limited targeted treatments options.
When that happens, doctors may need to review the treatment plan and this often requires resampling of the tumour. Currently, this involves a tissue biopsy that is invasive, requires hospitalisation, and is sometimes risky or not possible at all due to the location of the tumour or the particular patient circumstances. ASPiRATION 2L uses liquid biopsy testing to better understand the tumour’s molecular changes. This opens the door for patients to require a simple blood test (known as a ‘liquid biopsy’) to help identify the most appropriate next treatment.
What is a liquid biopsy in lung cancer?
A liquid biopsy is a blood test that detects fragments of tumour DNA called circulating tumour DNA (ctDNA) that are released into the bloodstream.
Compared to a traditional tissue biopsy, it is:
- Less invasive – no surgery or lung needle biopsy required
- Repeatable over time – can track tumour changes during treatment
- Fast – results can return sooner, allowing quicker treatment decisions
For people with lung cancer, liquid biopsy is particularly useful for detecting new mutations that emerge during treatment, potentially opening up targeted therapy or clinical trial options.
To learn more listen to the TOGA podcast about liquid biopsy with three leaders in the lung cancer field.
How ASPi-2L will achieve liquid biopsy informed precision oncology
Over the next five years, ASPiRATION-2 Liquid will:
- Recruit 500 Australians with metastatic non-small cell lung cancer (NSCLC) harbouring any actionable mutations whose cancer has progressed after targeted therapy.
- Use liquid biopsy to guide treatment decisions throughout a patient’s journey, not just at diagnosis. So even if a patient progresses after the initial liquid biopsy and tailored treatment through ASPi-2L, the opportunity will be available to repeat the liquid biopsy and personalisation of further lines of treatment.
- Connect patients to the most suitable therapies, whether through PBS-funded treatments, clinical trials, or other programs.
- Test the real-world benefits and cost-effectiveness of integrating liquid biopsy into standard care.
- Ensure equal access nationwide through telehealth, remote consent, and virtual molecular tumour boards.
How do ASPiRATION 2L results guide treatment?
Test results are reviewed by a Molecular Tumour Board (MTB) — a multidisciplinary panel of lung cancer experts. The MTB report to the referring clinician includes:
- Detected mutations or molecular changes
- Potential targeted therapy or standard care options
- Relevant clinical trials or drug access schemes
This liquid biopsy and MTB cycle is repeated at key stages of treatment, ensuring recommendations remain aligned with the cancer’s evolution.
Who can join the ASPiRATION 2L trial?
Any adult in Australia with oncogene-driven mNSCLC whose disease has progressed after first-line TKI therapy can be referred.
Participation pathways include:
- Activated trial site – patient’s hospital is a participating site
- Remote referral and consent – coordinated by the Sydney Clinical Trials Centre
Once enrolled, the referring site collects a blood sample for next-generation sequencing (NGS), which is analysed in a central laboratory.
Following the Molecular Tumour Board recommendation
Following the report, the clinician and patient may choose to:
- Continue the current standard of care
- Switch to another PBS-reimbursed therapy
- Enrol in a clinical trial (TOGA-led or industry-sponsored)
- Access treatment via a drug access program
All treatment options follow the usual regulatory and consent requirements.
Referring patients to the ASPiRATION-2L study
We want clinicians and cancer centres across Australia to be part of this national effort. There are two pathways to referring participants to the study:
1. Remote referral
Any medical oncologist in Australia outside of a participating site can refer a patient to the ASPi-2L study.
Eligibility is to be confirmed by the referring clinician and registration will be performed by the NHMRC CTC as soon as possible after informed consent has been obtained.
Click here for remote referral information and links, or contact the ASPi-2L study team at info.aspiration2@sydney.edu.au or call 02 9351 2409 for more information.
2. Enrolment at one of the participating sites
If you wish to refer a patient to one of the participating sites, please contact the relevant Principal Investigator or aspiration2.study@sydney.edu.au
Site | Principal Investigator |
|---|---|
ACT | |
Canberra Hospital | Geoffrey Peters |
NSW | |
Royal North Shore Hospital | Nick Pavlakis |
Chris O’Brien Lifehouse | Malinda Itchins |
Liverpool Hospital | Victoria Bray |
St George Hospital | Chee Lee |
Nepean Hospital | Pei Ding |
QLD | |
Princess Alexandra Hospital | Ken O’Byrne |
The Prince Charles Hospital | Brett Hughes |
Sunshine Coast University Hospital | Bryan Chan |
SA | |
Queen Elizabeth Hospital | Rachel Roberts-Thomson |
TAS | |
Royal Hobart Hospital | Rebecca Tay |
VIC | |
Peter MacCallum Cancer Centre | Ben Solomon |
St Vincent’s Hospital Melbourne | Melissa Moore |
Austin Hospital | Sagun Parakh |
Monash Medical Centre – Clayton | Surein Arulananda |
WA | |
Sir Charles Gairdner Hospital | Samantha Bowyer |
Fiona Stanley Hospital | Lydia Warburton |
How can I be more involved with ASPI 2L?
If you are interested in conducting a clinical trial or are involved in an ongoing clinical trial that would benefit from recruitment via ASPi-2L please submit the study concept or protocol to info@thoraciconcology.org.au.
TOGA’s concept process and further information can be found here.
Studies proposing to recruit through ASPi-2L will be reviewed by the ASPi-2L executive committee and if approved, will be mentioned on the MTB report when a relevant patient is identified. This opportunity is available to TOGA members, non-members and industry. The clinical trial needs to be independently funded. There may be some required sharing of data to enable follow up of patients on the main cohort study.
Learn more about TOGA clinical trials and how innovative studies are improving outcomes for people with lung cancer.
