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Biomarker Testing Continues to Develop in NSCLC

Danielle Bucco
Published: Thursday, Dec 28, 2017

Kathryn F. Mileham, MD

Kathryn F. Mileham, MD

Osimertinib (Tagrisso) is predicted to have a significant impact in the first-line setting for patients with EGFR T790M-mutated non–small cell lung cancer (NSCLC), explains Kathryn F. Mileham, MD.

on Non–Small Cell Lung Cancer, Mileham, a medical oncologist at Carolina HealthCare System, discussed the development of biomarker testing for patients with mutated NSCLC.

OncLive: What biomarkers are currently identified in NSCLC?

Mileham: The landscape of lung cancer has changed so much over the past 20 years. We used to look at lung cancer as small cell lung cancer versus NSCLC. Then we got more specific with the histologic subtypes for treatment purposes that, now, with the discovery of numerous mutations within adenocarcinoma or nonsquamous NSCLC, we have learned much more about biomarkers and biomarker testing in NSCLC. 

The advantage of using a broader molecular panel is that we are identifying other biomarkers all identified within NSCLC. They may not have an FDA-approved targeted therapy, but there are numerous clinical trials that are looking at some of these less common mutations. One of those trials is ASCO’s TAPUR trial. This trial gives a patient an opportunity to receive a therapy that is directed at that mutation, but may not yet be FDA approved in that indication.

What are the big questions that community oncologists have regarding biomarker testing?

The biggest challenge for biomarker testing in the community setting is determining which test to give and when. These therapies are giving better responses and better quality of life in improving cancer-related symptoms than their alternative therapy, which is often chemotherapy. If we are in that setting, we need to be testing for them. Currently, every patient with metastatic nonsquamous NSCLC should be checked for mutations in EGFR, ALK, ROS1, and BRAF, as well as PD-L1. 

What advice do you have for physicians to better understand which biomarker to test for or what to do following a biomarker test?

One of the challenges with biomarker testing in the community setting is not only determining which tests, but how to use the tissue from the sample that was obtained from the tumor. It is important for us to think about this because we need this information and, if tumor samples are not sufficient, we may not be able to get all the information that we need. We must make sure that our patients are getting large tissue samples and that we are communicating with our pathologist so that they are not misutilizing the tissue that we are collecting. 
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