Update on Genomic Testing for Patients With Lung Cancer
Posted: Tuesday, April 3, 2018
Genomic testing can be used to identify predictive biomarkers with tumors that harbor vulnerabilities to corresponding targeted therapies and is expanding as other strategies and technologies evolve, according to a review published in the Journal of the National Comprehensive Cancer Network. Céline Mascaux, MD, PhD, of the Cancer Research Center of Marseille in France, and colleagues describe the development of predictive biomarkers and the current status and utility of genomic testing in non–small cell lung cancer (NSCLC).
Current National Comprehensive Cancer Network (NCCN) guidelines recommend patients with nonsquamous NSCLC and select patients with squamous cell histology be tested for epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) rearrangements, and ROS1 fusions; RET fusions, BRAF mutations, and MET exon 14 mutations. In terms of targeted therapy against oncogenic drivers, EGFR tyrosine kinase inhibitors have been associated with an overall response rate of 68% and a progression-free survival of 12 months in patients with advanced NSCLC. Additionally, the panel of oncogenic drivers is growing, as are associated targeted therapies, researchers said, and this will continue as the use of multiplex testing becomes standard.
Moreover, PD-L1 expression is recommended before first-line treatment in patients with metastatic NSCLC with negative or unknown test results for EGFR mutations and ALK and ROS1 rearrangements. In the future, the emergence of cell-free circulating tumor DNA testing provides a noninvasive alternative to tissue testing and may allow testing for monitoring response or relapse to treatment.