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David P. Carbone, MD, PhD, and Niels Reinmuth, MD, PhD, discussed the landscapes of biomarker testing and screening in NSCLC.
With targeted treatments at the forefront of non–small cell lung cancer treatment, next-generation sequencing (NGS) and other biomarker testing approaches should enable widespread accessibility to ensure that these agents can improve outcomes for as many patients as possible, according to David P. Carbone, MD, PhD, and Niels Reinmuth, MD, PhD.
“Molecular testing has transformed lung cancer treatment, and we now have 2 major pillars of therapy, with immunotherapy and targeted therapies, that apply to patients of virtually every stage,” Carbone, the coleader of the Translational Therapeutics Program and the director of the Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center—James, as well as a professor of internal medicine at The Ohio State University in Columbus, said.
“We can [now] see patients with stage IV NSCLC living a normal life, despite [having] stage IV [disease] or even brain metastases. [They can] go to work and do what [individuals] without lung cancer do,” Reinmuth, the leader of the Thoracic Oncology Department at the Asklepios Lung Clinic in Munich-Gauting, Germany, added. “This is remarkable, and it’s only possible if we find and define those molecular alterations.”
During an OncLive Insights video program on operationalizing screening in NSCLC, Carbone and Reinmuth discussed the importance of biomarker testing across the NSCLC spectrum, approaches to streamlining biomarker testing, and the state of lung cancer screening.
The investigators began their discussion by noting that insufficient biopsies remain an obstacle to widespread biomarker testing. However, Carbone noted that new techniques such as navigational bronchoscopy and endoscopic ultrasound could help to close this gap. He also noted that collaboration with a multidisciplinary team that includes radiologists and pulmonologists is crucial to ensure timely biomarker testing so that the treating oncologist can have the results on hand during the first visit with the patient.
“With the delayed return of results, often patients get started on something that’s not ideal, and sometimes never get the appropriate therapy,” Carbone commented. “It’s now very clear that we need to not just test [patients with] stage IV cancer, but we need to test anything at stage IB or II and higher.”
The pair then shifted their discussion to highlight the importance of PD-L1 testing in guiding treatment in NSCLC. “We test every patient for PD-L1 using a certified platform, and we rely on the result, but we understand that with a different platform we may get slightly different results as well. So, it’s not the only determinant we base our treatment decision on,” Reinmuth explained.
Carbone added that patients with a new diagnosis are often upset and want to start treatment on chemotherapy immediately, even if testing results are not yet available. If a patient has bone or brain metastases and needs to receive treatment immediately, this practice is acceptable while waiting for NGS results, Reinmuth stated.
“It’s important to have a comprehensive and quality diagnosis at the beginning, [then] you can have reliable [NGS] results in 5 to 10 days,” Reinmuth explained. “There are sometimes reasons why we cannot wait to start [treatment], but we try to have to keep this kind of fraction of patients low. [However], it does happen.”
Reinmuth began the portion of the conversation on lung cancer screening by highlighting findings from the Dutch-Belgian NELSON trial (NL580), which examined whether volume-based, low-dose CT screening could reduce lung-cancer mortality among patients who were current or former smokers.1 Findings from the study demonstrated that the cumulative ratio for death from lung cancer at 10 years was 0.76 (95% CI, 0.61-0.94; P = .01) among male patients in the screening group compared with the control group. After 10 years of follow-up, this ratio was 0.67 (95% CI, 0.38-1.14) among female patients.
“[We need to] run an AI-based evaluation program, which will try to minimize the additional workload of radiologists because we know that we don’t have that many doctors to fully implement the whole program for the whole community,” Reinmuth commented.
Carbone noted that although lung cancer screening via low-dose CT scan has been approved in the United States since 2015,2 the uptake of eligible patients being screened remains low. He added that the number of individuals receiving low-dose CT scan screening is gradually improving, but emphasized that the procedure needs to be ordered by primary care physicians.
“Getting this process implemented in the general medical clinic practice is difficult, and it can take some time,” he said.
