Actionable Mutations in NSCLC: Expert Perspectives in Testing and Targeted Therapy - Episode 4

Challenges Associated with Molecular Testing in NSCLC

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A look at the challenges associated with different molecular testing methods and the barriers that patients with non–small cell lung cancer face in getting tested.

Ben Levy, MD: Let’s talk tissue. Obviously, procurement and tissue stewardship is a big issue. It’s travel time from the needle to the slide to the pathologist to the NGS [next-generation sequencing]. There are a lot of challenges and hurdles that can happen along the way. Hatim, is tissue sufficiency a challenge at your institution [the University of California San Diego]?

Hatim Husain, MD: Tissue insufficiency has been less of a problem, partly because of education among our multidisciplinary team, specifically involving interventional pulmonary and interventional radiology, who have also understood the importance of genomic profiling. When you have the whole health care team concerted around a focus, it helps facilitate some of these barriers. It requires working [together]. Dr [Timothy Craig] Allen elegantly and appropriately made a comment about communication among the team and how it can drive optimization. In our place, we’ve been trying to do that by including the whole multidisciplinary team, including interventional pulmonary and interventional radiology, in some of the education about the molecular drivers.

Ben Levy, MD: Yes, communication is key, and even having a physician champion who can make sure that everyone is on the same page at the institutions is critical to getting this done. It can be a challenge. Fernando, rounding us out, we’ve talked about some of these strategies, but what are your thoughts on strategies to help improve testing rates for molecular biomarkers in lung cancer, both in the academic and community settings?

Fernando C. Santini, MD: One very important point is to make sure it’s tissue negative for drivers and not just insufficient tissue. We can’t take for granted that the tissue is negative. We must make sure we have enough tumor content and enough cells were analyzed. Read more lines from the molecular report. It’s important in making sure you’re giving the best care. Multidisciplinary awareness of the importance of the molecular analysis is key.

Ben Levy, MD: Yes, it takes a village to get testing done. Everyone said that it takes a concerted effort to make sure this is done efficiently and effectively, with results that are timely. Liquid biopsy plays a huge role. It doesn’t solve all the issues, but it clearly can help with rapid turnaround time, especially with patients who shed. You can identify an alteration and act on it without having to wait for the tissue, for the most part. There are clearly challenges with liquids, and we don’t have time to go into all the things that liquid biopsies can discover in addition to circulating tumor DNA, but it certainly has revolutionized the diagnostic algorithm.

Transcript edited for clarity.