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Expert Explains Limitations of Molecular Profiling in Lung Cancer

Caroline Seymour
Published: Thursday, Aug 09, 2018

Dara L. Aisner, MD, PhD

Dara L. Aisner, MD, PhD

Though testing for molecular abnormalities can determine a course of treatment for patients with non–small cell lung cancer, it can also muddle their treatment options if not examined properly, explained Dara L. Aisner, MD, PhD.

State of the Science Summit™ on Advanced Non–Small Cell Lung Cancer, Aisner, an associate professor in the department of Pathology at the University of Colorado School of Medicine, discussed the rapidly progressing field of molecular profiling, the importance of understanding assay results, and how they translate to patient care in lung cancer.

OncLive: What did your presentation on molecular profiling focus on?

Aisner: Some of the things that I wanted to [express] in my presentation are understanding the limitations of testing and understanding that no test is perfect.

Another point is that technologies are evolving very rapidly. What is exciting and interesting today is not going to be what we're talking about in a few years. There's a balance to be had between jumping for a test because it's new and “hot,” versus going for data that are well established. There's a real middle ground in between those 2 extremes.

Can you elaborate on some of the cases you consulted on?

A lot of this has to do with the fact that this is a relatively new area for oncologists. When many people who are in practice now went to medical school, this was not part of practice. It's something that we are incorporating into the training of oncologists today, but even in that setting the technology is so complex.

This is where the multidisciplinary team becomes important. Having somebody who understands the technical aspects of the test in very fine detail as part of a multidisciplinary team can be advantageous. This is about education, learning how to read the reports, and learning when you need help in digging deeper. As we mature in our use of this type of testing, we will see that people will get better at figuring out how to go from a report to what this means for my patients.

How should these tests be conducted?

The “how” is really the elephant in the room for most people. It's really challenging, because on one hand you want to do what's easiest and fastest. On the other hand, if you don't necessarily know all of the technical details, you don't know if the [test] that is billed will answer all of the questions you want answered.

The “how” has to be centered around the goal for the patient. If a patient is frail with poor performance status, getting a huge test that may make them eligible for clinical trials perhaps isn't the right approach. Conversely, if you have [a patient] who is very aggressive about wanting to treat their disease, perhaps you want to be more comprehensive from the outset. It’s not a one-size-fits-all approach.

Does the time of assessing PD-L1 and tumor mutational burden make a difference?

I don't think we have answered that yet. Pretty much all of the studies that have been done have looked at those values before immunotherapy treatment. There have been some discussions about [whether] immunotherapy is more effective in the neoadjuvant versus adjuvant setting.

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