Shirley Michelle Shiller, DO
The advancements in the treatment paradigm of non–small cell lung cancer (NSCLC) stem from the development of biomarker-driven therapy, liquid biopsies, and effective single-agent immunotherapy and combination regimens.
However, as the diagnoses within the world of lung cancer become more diversified, the need for healthcare provider overlap and communication becomes more important than ever, according to Shirley Michelle Shiller, DO.
“There has never been another time in medicine greater than right now, in which we really need to be working together,” said Shiller. “We need to better communicate and talk with the clinicians, specifically the oncologist, pulmonologist, thoracic surgeon, interventional radiologist, and pathologist. The more we talk, the greater we can get a higher yield for the patient. By doing this, we will be able to get the result and consequent treatment to patients sooner, confident that it is right for them.”
In an interview during the 2018 OncLive®
State of the Science SummitTM
on Non–Small Cell Lung Cancer, Shiller discussed the application of biomarkers in treatment and the importance of educating practitioners on treatment advancements in NSCLC.
OncLive: Can you provide a summary of your presentation on NSCLC?
This talk focused on helping our clinical colleagues understand some of the methods that are behind getting them the test results that drive the targeted therapy downstream. There's a large gap in education in terms of the techniques that are utilized at the molecular level and the results that they get. There's a lot of complexity, there are a lot of ways to do it, and now is the time to help them feel empowered with that information.
How reliable is PD-L1 as a biomarker?
PD-L1 is a good biomarker in terms of assessing immunoexpression. The thing that is unique about it versus looking at EGFR
is that the immune system is always in flux, so it occurs along a continuum. The results of it can vary not only within one specimen on its own, but also within separate time points. It’s reliable in terms of knowing it’s being expressed, but the expression can widely vary.
What are some of the major challenges regarding biomarker testing?
Some of the major challenges we are facing are, first and foremost, the FDA issuing companion diagnostics without really engaging the pathologist in terms of its performance characteristics. We also need to work together to streamline which markers we are using for PD-L1, as an example. Though there are FDA companion diagnostics in other spaces, for years the testing was also done in labs throughout the country with similar results that weren't overseen, governed, or given a companion diagnostic designation by the FDA.