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We recently hosted a webinar called “Optimizing NSCLC Treatment with Biomarker Testing Insights”, featuring Dr. Jessica Lin of Mass General Cancer Center. In it, Dr. Lin discussed how biomarker testing identifies genetic mutations and resistance mechanisms in non-small cell lung treatment, informs better treatment decisions, and influences patient care. Listen to the replay and learn about the latest advancements that are transforming NSCLC treatment and driving improved patient outcomes.
**A summary of the discussion is below**
Biomarker testing is becoming increasingly essential for patients with non-small cell lung cancer (NSCLC), offering personalized treatment options that can significantly improve outcomes. However, patients and caregivers may not always be aware of its importance, particularly in early-stage cancers. This post explores the basics of biomarker testing, why it’s critical to discuss with your healthcare provider, and the evolving options available to ensure accurate diagnosis and treatment.
What Is Biomarker Testing?
Biomarker testing involves examining specific genetic mutations or molecular changes in a patient’s cancer. For NSCLC, these biomarkers can help identify targeted treatments that are more effective for certain types of lung cancer. Early biomarker testing at the point of diagnosis can influence treatment plans, helping oncologists decide on the most appropriate course of action.
Historically, biomarker testing in lung cancer focused on mutations like EGFR and ALK. However, advances have expanded the panel to include newer markers such as HER2, MET exon 14, and KRAS, which are now part of standard testing recommendations by the National Comprehensive Cancer Network (NCCN) for advanced-stage and even earlier-stage lung cancers.
When Should Biomarker Testing Be Done?
For advanced and metastatic lung cancer, biomarker testing is standard and should be done at the time of diagnosis. Recent guidelines also recommend testing in earlier stages (Stage I-III) to guide decisions about postoperative care or treatments after chemotherapy and radiation. Studies show that, despite recommendations, biomarker testing rates remain suboptimal, with up to 50% of advanced-stage patients not receiving full biomarker panels. Therefore, patients should feel empowered to ask their doctors about biomarker testing and understand any reasons for delays or exclusions in testing.
Why Biomarker Testing May Be Overlooked
Biomarker testing may be overlooked or delayed for several reasons:
- Rapidly Changing Guidelines: The rapid development of biomarker testing panels and targeted therapies can result in guideline adoption delays.
- Community Practice Differences: Smaller or community-based practices may be slower to adopt comprehensive testing due to resource constraints.
- Biopsy Challenges: Some tumors are not easily accessible for biopsy, or there may be insufficient tissue to conduct all necessary tests, which can necessitate additional biopsies.
The Role of Liquid Biopsies
For patients where traditional biopsies are difficult or unsafe, liquid biopsy is an alternative. Liquid biopsy involves using a blood sample to detect specific mutations, making it less invasive and a valuable complement to tissue biopsies. While liquid biopsies can identify mutations, they may sometimes fail to detect changes if not enough cancer DNA is present in the bloodstream. In such cases, a tissue biopsy might still be necessary to confirm the diagnosis.
Moving Forward: Discussing Biomarker Testing with Your Doctor
- Ask About Biomarker Testing: Patients should inquire about biomarker testing and feel empowered to discuss its importance with their healthcare team.
- Understand Testing Results: If a liquid biopsy returns no detectable mutation, patients may need a follow-up tissue biopsy to ensure a comprehensive assessment.
- Consider Clinical Trials: For patients without targetable mutations, clinical trials may offer access to emerging therapies.
By understanding biomarker testing and discussing options with healthcare providers, NSCLC patients can ensure they receive the most personalized and effective care available.
