What to Know About Biomarker Testing for Lung Cancer: An Expert Q&A

Howard (Jack) West, MD, is the scientific govt director for AccessHope and a medical oncologist specializing in lung most cancers at Metropolis of Hope in Duarte, California. Dr. West can be the founding father of the Global Resource for Advancing Cancer Education (GRACE)a nonprofit group devoted to offering well timed, free, credible data to individuals with most cancers and caregivers all over the world. Dr. West is a 2022 Cancer.Net Lung Cancer Advisory Panelist. You possibly can observe Dr. West on Twitter. View Dr. West’s disclosures.

Biomarker testing, which can even be known as molecular testing or tumor marker testingis when medical doctors carry out detailed research on tumor tissue taken throughout a biopsy or blood pattern to know the particular options of an individual’s most cancers. Biomarkers are substances present in higher-than-normal ranges within the blood, urine, or tissues of some individuals with most cancers. Biomarkers may also consult with mutations, adjustments, or patterns in a tumor’s DNA.

Figuring out particular biomarkers of a tumor is necessary as a result of some mutations, notably in individuals with lung cancermight be “drivers” of the most cancers, which signifies that they could be a major explanation for that most cancers rising and dividing.

Why can biomarker testing be useful in treating an individual with lung most cancers?

There was important analysis executed to establish particular mutations present in lung most cancers. For a lot of of those mutations, there’s a sort of remedy known as targeted therapy accessible to focus on completely different, particular mutations. These focused therapies have been confirmed in scientific trials to be efficient in treating lung cancers with these mutations.

Focused remedy works by focusing on the most cancers’s particular genes, proteins, or tissue surroundings which might be contributing to most cancers progress. These therapies can then gradual, cease, or destroy the most cancers. Figuring out which biomarkers your lung most cancers has is necessary as a result of, in some circumstances, there could also be a focused remedy accessible to successfully block mutations discovered within the most cancers which may be driving the most cancers’s progress and survival.

For that reason, biomarker testing is a important a part of planning remedy for any particular person with superior lung most cancers and doubtlessly different individuals with different phases of lung most cancers. Not all lung cancers have a “driver mutation,” however for people who do and which have an related focused remedy accessible to dam that mutation, it’s typically the best method for treating that most cancers. Focused remedy might also trigger fewer unwanted side effects than different therapies as a result of it limits injury to wholesome cells.

When is biomarker testing executed in lung most cancers care?

Biomarker testing is most helpful for individuals with superior or stage IV non-squamous NSCLC. Since there are such a lot of biomarkers that exist, biomarker testing might be executed utilizing a broad testing panel, similar to next-generation sequencing (NGS). Such a testing can search for dozens to tons of of biomarkers directly and appears for all biomarkers which have a focused remedy at present accessible to deal with them, in addition to many different biomarkers which will turn into treatable sooner or later. Individuals with superior squamous cancers who’ve little or no prior smoking historical past or whose tumors have a mix of squamous and non-squamous elements might also obtain biomarker testing.

Past superior NSCLC, biomarker testing might also be executed in some individuals with earlier stage NSCLC and fewer generally in some individuals with small cell lung cancer (SCLC). Particularly, your physician could suggest restricted biomarker testing to search for mutations within the EGFR and ALK genes, as these are frequent biomarkers present in earlier-stage illness and could also be handled with focused remedy. Many oncologists might also contemplate biomarker testing to assist inform different choices in stage I to stage III NSCLC. Nonetheless, there may be not but a transparent consensus about biomarker testing as a regular of care exterior of stage IV lung most cancers presently.

What ought to individuals with most cancers anticipate if biomarker testing is really useful for them?

First, know that the method of biomarker testing can take a number of weeks. Ideally, the testing might be executed from tumor tissue that has already been eliminated throughout a biopsy process. Nonetheless, even on this case, testing will nonetheless sometimes take at the very least 2 to three weeks. Typically, it could take as much as 4 weeks to obtain all the detailed outcomes again from a tumor tissue pattern, notably if the pattern has been despatched to a different facility. Nonetheless, whereas ready for these outcomes could also be difficult, do not forget that the outcomes are of important significance to your most cancers remedy and are wanted to information you to one of the best remedy plan.

In some circumstances, when there may be not enough tissue to do all the required testing, your physician could suggest an extra biopsy to acquire extra tissue. This could possibly be executed via an image-guided method, similar to with a computed tomography (CT) scanor via a bronchoscopythroughout which the physician takes fluid from exterior of the lung.

One other methodology for biomarker testing in lung most cancers that has emerged known as a “liquid biopsy.” Throughout a liquid biopsy, the physician attracts blood and evaluates the plasma for most cancers DNA circulating within the bloodstream, which can establish some related biomarkers. Whereas the flexibility to detect biomarkers via this kind of biopsy is just not fairly as sturdy as that of a tissue biopsy, at the very least in individuals with a low quantity of most cancers of their physique, this selection does allow extra individuals to obtain biomarker testing. Outcomes are sometimes accessible inside 1 to 2 weeks after blood is drawn. Importantly, if a particular mutation is recognized via a liquid biopsy, it may be trusted as a sound method to information remedy.

What questions ought to individuals with lung most cancers ask their physician about biomarker testing?

There are a number of questions that will be useful to ask your physician. These questions embrace:

1: Has biomarker testing been ordered for me? Why or why not?

That is the primary query it is best to ask.

There could also be a cause your physician has not ordered biomarker testing. For instance, you’ll have an early-stage most cancers the place the outcomes wouldn’t clearly be useful in guiding remedy suggestions. Or, it could possibly be that you’ve a subtype of lung most cancers that may be very unlikely to have a focused biomarker.

2: Will I must have one other biopsy or blood-based check for biomarker testing?

In case your physician is worried there is not sufficient tissue for biomarker testing, then a repeat biopsy or sending off a blood-based check could also be vital.

3: Will remedy be delayed till my biomarker testing outcomes are again?

Speak together with your physician about how the timing of biomarker testing might have an effect on the timing of your remedy. Typically, the physician could wish to wait to start out your lung most cancers remedy so you may have all the details about your most cancers earlier than making a call. Nonetheless, in some circumstances, it is perhaps vital to start out remedy earlier than biomarker testing outcomes are again. In such circumstances, chemotherapy alone is commonly used till biomarker testing has been accomplished.

4: Is biomarker testing coated by my medical health insurance?

It’s acceptable to ask this and another questions you might need about whether or not biomarker testing is roofed by your health insurance. Most insurance coverage suppliers now contemplate biomarker testing a regular of look after the teams of sufferers described above, which implies it’s typically coated.