Global Perspectives in the Treatment of EGFR-mutant Resectable and Advanced NSCLC - Episode 3

How Has Biomarker Testing Impacted Clinical Practice Across Geographic Regions?

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A broad review on how biomarker testing has impacted the clinical staging and management of non–small cell lung cancer across geographic regions.


Tony S.K. Mok, MD: Lu Shun, can you mention how genetic testing changed your practice? You have been in this for 20 years now since we grew up together. Just briefly, how does NGS [next-generation sequencing] impact on your day-to-day clinical practice?

Shun Lu, MD, PhD: As you know, at the beginning, we were using the PCR [polymerase chain reaction]. Go back to the past time. At that time, we were only focused on the EGFR. Then we come to the ALK. We’re using the FISH [fluorescence in situ hybridization] or immunohistory. But after that, right now, we’re using NGS because [INAUDIBLE] we should test at least the next 5 or 10 genes. So we needed a multi-practice test to cover all these, we call it a hotspot, trying to identify which gene profile can get a benefit from the treatment. So, right now, NGS, why did we use it? Because it can answer several questions. Right now, for the big institute in China, as Dr. Wu already mentioned, we’re using the NGS to test the disease gene—the 10 gene. So that will help us with treatment. The second is that you know right now that [INAUDIBLE]. We try to use it as the second elimination, or we needed to know that drug mechanism of resistance. We also needed the so-called big panel to identify the mechanism of the drug resistance. So we like to use it not only in the first biopsy, using NGS, but also in the second biopsy and maybe the third biopsy we need NGS to help us to choose the right patient to receive the right treatment.

Tony S.K. Mok, MD: So you do that routinely for resistance. In the diagnosis and also at the resistance. Do you select your patients who do that or do you just say certain patients that you do the molecular testing?

Shun Lu, MD, PhD: Especially for resistance, if the patient can get the biopsy, we’re routinely using the tissue biopsy to do the NGS. But only for the patient that cannot get the tissue, or very difficult to get a tissue, maybe we’re using liquid biopsy to test these patients.

Tony S.K. Mok, MD: Myung-Ju, is it a routine practice that you also do a NGS in all resistant cases in EGFR and ALK?

Myung-Ju Ahn, MD: Not all of them. Regarding the EGFR mutation, we do both the EGFR, the separate DNA, repeat biopsy for the EGFR, and then the tissue biopsy. Not the NGS, but just the EGFR test.

Tony S.K. Mok, MD: I see.

Transcript edited for clarity.