Thomas Zander, MD, far right, at the ASCO press conference where his community screening study was discussed. Also on the panel are, from left, George D. Demetri, MD, Caroline Robert, MD, PhD, Axel Hauschild, MD, and James Chih-Hsin Yang, MD, PhD.
The development of targeted therapies for a variety of tumor types has highlighted a greater need for widespread molecular testing to determine which patients have the mutations that these therapies target, and oncologists throughout the world are trying different approaches to translating such advances into broad clinical practice.
In Germany, the feasibility of a community screening program for patients with non-small cell lung cancer (NSCLC) was explored, a strategy that provoked discussion at this year’s annual ASCO meeting.
“High-quality molecular diagnostics and personalized treatment approaches present a significant benefit for patients,” said Thomas Zander, MD, of the University Hospital in Cologne, Germany, during a press conference at which his study was discussed.
“At last year’s ASCO meeting, [studies of] large networks for molecular screening testing were presented which consisted of several highly specialized comprehensive cancer centers spread all over the United States, but it meant that getting access to molecular diagnostics was only available to a minority of patients in this country,” Zander said.
Zander’s study focused on testing patients outside of large academic medical centers. In order to perform the study, researchers established the Network Genomic Medicine Lung Cancer. This network included community hospitals in the Cologne-Bonn region of the country, where approximately 2.5 million residents could potentially receive screening.
In all, 2032 samples from NSCLC patients were collected, the authors reported in their abstract. The figure includes 1782 samples from residents of the Cologne-Bonn region, which investigators estimate accounts for between 60% and 70% of all potential NSCLC samples in the area.
Of these samples, 77% were suitable for molecular testing. Samples of tumors of patients with lung adenocarcinoma–the most common form of NSCLC–were screened for ALK translocations, mutations in KRAS
, and PIK3CA
, and amplification of ERBB2
. Squamous cell samples were screened for FGFR1
Forty percent of the samples carried mutations for which targeted therapies have been identified, aiding the community hospitals in providing treatment to these patients. For example, patients with ALK
mutations were given crizotinib, and patients with EGFR
mutations were given EGFR tyrosine kinase inhibitor treatment. Additionally, patients were also referred to clinical trials based on their genetic profiles that involved the testing of other targeted therapies in development.
NSCLC by Subtype and Mutation Frequency1
77% of samples suitable for mutation analysis
NSCLC indicates non-small cell lung cancer, NOS, not otherwise specified.
Zander said the cost for the screenings ranged from approximately €500 to €1000 per patient. ($600 to $1200).
In the United States and elsewhere, different models are being used. Panel members commented from their vantage points.
“We’re doing a $35 million philanthropically funded trial where patients are allowed access to molecular diagnostics and information is fed back as clinically actionable, and they’re not charged for it,” said George D. Demetri, MD, director of the Center for Sarcoma and Bone Oncology at the Dana-Farber Cancer Institute in Boston, Massachusetts.
“We think that’s important because in the next five years we need that landscape to see what’s truly actionable, what’s truly important, and then we feel that we can commoditize the molecular testing,” said Demitri. “I think that’s what you’re seeing across the world.”
In France, the French National Cancer Institute has set up 28 laboratories in public hospitals to test for biomarkers, and all patients with cancer receive free testing for biomarkers such as KRAS
, and BRAF
. However, these clinics are limited to proven biomarkers.