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Blood-Based Assays Are Addition, But Not Replacement for Lung Tissue Biopsies

Gina Columbus @ginacolumbusonc
Published: Wednesday, Jul 05, 2017

Leora Horn, MD

Leora Horn, MD, MSc

The boom of blood-based biomarkers has led to a turning point in clinical practice for physicians treating patients with non–small cell lung cancer (NSCLC). While tissue biopsies remain the standard approach, plasma assays—if positive—can direct patients to a first-line targeted treatment quicker.

State of the Science Summit™ on Advanced Non–Small Cell Lung Cancer, Horn, an associate professor of medicine (hematology and oncology), assistant director of the Educator Development Program, clinical director of the Thoracic Oncology Program, and medical oncologist at Vanderbilt-Ingram Cancer Center, discussed the utility of blood-based biomarkers, how they have transformed treatment approaches for patients with NSCLC, and the ongoing work currently being done with them.

OncLive: What did you discuss in your lecture at the meeting?

Horn: The talk was about biomarkers and, specifically, the use of blood-based biomarkers in lung cancer. As you know, last year, the FDA approved EGFR testing via blood for patients with stage IV NSCLC that was adenocarcinoma. We talked about the role of a biomarker, both [as] a predictive [and] a prognostic factor. Predictive is the more important one, which can tell you if a patient will likely or not likely benefit from a specific therapy.

Also, for blood-based biomarkers, they are not perfect. If a patient has stage IV lung cancer and you send for a blood-based test and it comes back as negative, that is not enough to say we shouldn’t treat a patient with a certain therapy. That patient should go on to get a tissue biopsy, which would allow you to get better results. Blood-based biomarkers are only about 80% sensitive; that means that, in 20% of patients, we are missing a correct result. We also talked about the fact that PD-L1 testing has become standard of care for first-line therapy for patients with lung cancer, but it cannot be done by a blood [biomarker] yet. That is likely to be something that emerges in the near future.

What impact has this type of assay had on clinical practice?

It is a nice option for patients who have had maybe 1 or 2 biopsies that have been unsuccessful. I’ll discuss it with patients and tell them, “If the blood is positive, it gives you an answer. If it’s negative, it does not give you an answer.” For those patients who maybe had a couple of unsuccessful biopsies where we didn’t get enough tissue for molecular testing, a blood-based test can hopefully provide that information for us in helping select therapy.
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Online CME Activities
TitleExpiration DateCME Credits
Advances in™ Therapies for Patients With ALK-Positive Lung Cancers: More Options…More Decisions…Better OutcomesAug 30, 20191.5
Oncology Briefings™: Treating Advanced NSCLC Without Actionable MutationsAug 30, 20191.0
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