Campaign promotes comprehensive genomic testing of patients with advanced NSCLC
Click Here to Manage Email Alerts
The use of genomic testing to identify actionable mutations and match patients to targeted therapies has had a dramatic impact on cancer treatment.
The National Comprehensive Cancer Network recommends testing for 10 biomarkers before starting initial treatment for advanced non-small cell lung cancer. However, researchers found only 18% of patients receive this guideline-recommended genomic testing, leaving the remainder at increased risk for subpar treatment.
“In NSCLC, discovering these mutations has been essential, because it has clearly changed the treatment paradigm for stage IV disease,” Martin Gutierrez, MD, medical oncologist at Hackensack Meridian Health, said in an interview with Healio. “Response rates are now 60% to 70% with median survival rates in the 3-year-plus window, so it obviously makes a difference.”
To draw attention to the importance of genomic testing in guiding treatment decisions for these patients, Guardant Health and three patient advocacy groups — Go2 Foundation for Lung Cancer, LUNGevity Foundation and ALK Positive — have collaborated on the Clear Your View campaign.
Healio spoke with Gutierrez about the awareness campaign and the value of targeted treatment for patients with advanced NSCLC.
Question: How have targeted therapies changed the landscape of lung cancer treatment?
Answer: Oncology has changed a lot in the past 20 years. One of the biggest changes was finding gene-driving mutations, specifically EGFR in exons 19, 20 and 21, and developing targeted therapies for those mutations. That opened the door for gene sequencing of patients with lung cancer and discovery of their mutations, which led to the development of tyrosine kinase inhibitors. Then we started to develop TKIs to target the genetic alterations in NSCLC. We were able to change the outcomes for this subset of patients with lung cancer. We went from a 20% to 30% response rate with survival of less than a year to having a subset of patients with a response rate of 60% to 70% and median survival of over 3 years.
There also has been a very dramatic change in terms of quality of life. Patients treated with a therapy can have a follow-up by the physicians with telemedicine and appropriate labs.
So, everyone with stage IV NSCLC should have genomic testing. It should start with tissue for comprehensive testing. If there is not adequate material, which frequently is the case in NSCLC, circulating tumor DNA (ctDNA) is a phenomenal tool to establish a diagnosis.
Q. Why do so few patients with advanced NSCLC undergo genomic testing?
A: I think the logistics make it difficult. These might involve not having enough tumor cells for fine needle aspiration. Or, depending on where patients and practices are located, performing the test and using it to inform treatment decisions can be time consuming. I think to some degree, the logistics are cumbersome, because you are ordering a test that can take 15 to 20 days to produce an answer.
Q: What impact has this low rate of genomic testing had on the outcomes of patients with advanced NSCLC?
A: Median survival and response rates are clearly impacted. We know that patients with genetic driver mutations are less likely to respond to immunotherapy, and their response rates and survival with chemotherapy only would be suboptimal by today’s standards.
Also, if you treat the patients appropriately with the appropriate targeted therapy, it leads to significantly improved outcomes, with fewer hospitalizations and ED visits. That makes a big difference.
Q. What does the awareness campaign aim to communicate about genomic testing for this population?
A: One of the steps we’ve been taking is to increase awareness about ctDNA. Genomic testing usually can be done in tissue, but it also can be accessible through ctDNA. Tissue is important, but if it is not available, ctDNA can establish the diagnosis for the vast majority of patients. Also, there is an issue of timing. If I have a fine needle aspiration and I know there isn’t going to be enough tissue to do comprehensive testing, cutting another biopsy and waiting for the results will add time to the process.
For more information:
Martin Gutierrez, MD, can be reached at 92 Second St., Hackensack, NJ 07601.
Collapse
Read more about
Click Here to Manage Email Alerts