Best Practices in NSCLC Molecular Testing, Part I

Panelists: David R. Gandara, MD, UC Davis; Corey J. Langer, MD, Penn Medicine;
Alan B. Sandler, MD, OHSU; Mark A. Socinski, MD, University of Pittsburgh;
Anne S. Tsao, MD, MD Anderson
Published Online: Wednesday, January 23, 2013
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Alan B. Sandler, MD, begins the conversation on the best practices and guidelines in non-small cell lung cancer (NSCLC) by saying that he tests all tumors by the Sequenom System or Ion Torrent. For practice purposes, Sandler suggests following NCCN guidelines, which is to test all patients for the EGFR mutation and EML4-ALK, regardless of smoking history.

Mark A. Socinski, MD, echoes Sandler and adds that actionable molecular findings are EGFR mutations and EML4-ALK translocations. In his practice, Socinski also tests for BRAF, KRAS, and RET to identify patients for clinical trials; however a drug for those subsets is not currently approved.

Corey J. Langer, MD, comments on the amount and quality of a core biopsy. He says that while the amount of tissue matters, the cellularity of the tissue is more important.

Anne S. Tsao, MD, says that, in the right hands, risk to the patient is minimalized with CT-guided interventional core biopsies of the lung. In addition, endobronchial-guided, ultrasound-guided biopsies are becoming standard practice and good tissue can be biopsied from the mediastinum. Tsao says she will not do bone biopsies as it’s difficult to get enough tumor tissue.

View Part II of the discussion
View More From This Discussion
Episode 1 Introduction: Advances and Issues in NSCLC
Episode 2 Best Practices in NSCLC Molecular Testing, Part I
Episode 3 Best Practices in NSCLC Molecular Testing, Part II
Episode 4 Molecular Testing and Actionable Targets in NSCLC
Episode 5 Concurrent Versus Sequential Testing in NSCLC
Episode 6 Rebiopsying and Molecular Testing in NSCLC
Episode 7 Selecting a Laboratory for Molecular Testing in NSCLC
Episode 8 Selecting Treatment for First- Line Non-Squamous NSCLC
Episode 9 Squamous Cell Carcinoma Treatment Options
Episode 10 Molecular Heterogeneity in Non-Small Cell Lung Cancer
Episode 11 Promising Emerging Classes of Therapies in NSCLC
Episode 12 Access to Molecular Testing Therapy in NSCLC
Episode 13 Personalizing the Treatment of Lung Cancer
Episode 14 Impact of EGFR Mutations on Treatment Decisions in NSCLC
Episode 15 The Cost-Effectiveness of Targeted Therapies in NSCLC
Expert Panelists
 David R. Gandara

David R. Gandara, MD

Director, Thoracic Oncology Program,
University of California, Davis Comprehensive Cancer Center
Sacramento, California

Corey J. Langer, MD

Director, Thoracic Oncology, The University of Pennsylvania Abramson Cancer Center
Philadelphia, Pennsylvania

Alan B. Sandler, MD

Professor of Medicine in Hematology & Oncology, Oregon Health & Science University, Portland, Oregon

Mark A. Socinski, MD

Director, Lung Cancer Section, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania

Anne S. Tsao, MD

Director, Mesothelioma Program, The University of Texas MD Anderson Comprehensive Cancer Center
Houston, Texas
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