Comprehensive Biomarker Testing: What It Means and Who Should Get It

This year in the United States, approximately 235,760 people will be diagnosed with lung cancer and nearly 131,880 will die of the disease.

As a thoracic medical oncologist, it is my duty to provide treatment and take care of people who have lung cancer. Throughout my career, I have been fortunate to witness a significant improvement in how we understand and treat this awful disease. However, there are still some common misconceptions about the nature of lung cancer and how we treat it. As November marks Lung Cancer Awareness Month, it is crucial to spread education and awareness about the importance of comprehensive biomarker testing in the lung cancer treatment process.

(Kathryn Mileham, MD, FACP, Atrium Health Levine Cancer Institute, LCI Board of Directors)

For context, lung cancer is not just one disease – instead, there are various types of lung cancer that are driven by different genetic mutations in the tumor. While not all lung cancers contain mutations, we have learned there are certain mutations that will be the main driver of the cancer in many situations. One of the primary goals of the cancer treatment team is to determine the path that will be driven by the cancer’s mutation and then block that path by targeting the mutation itself. As with other cancer treatments, the primary mission is to target the mutation to stop the spread of and, ultimately, shrink the cancer.

Targeting the mutation hinges on testing to accurately identify the mutation. Testing for a variety of biological mutations in the tumor at the same time is called comprehensive biomarker testing. Identifying certain biomarkers, the underlying biological mutations of the tumor, allows for the use of personalized medicines, which are “tailor-made” treatments that consider a patient’s cancer profile and personal genetics.

Without comprehensive biomarker testing, there is limited knowledge of whether a mutation is driving the way a cancer behaves and if a targeted treatment can be recommended. For example, without biomarker testing, we might miss an opportunity to provide targeted oral treatment, rather than intravenously. The key takeaway for patients is that comprehensive biomarker testing should be completed and that the results should be reviewed to determine whether a mutation is identified, if a targeted treatment is available, or if a clinical trial is an option. Knowing the patient’s biomarkers will also help them and their doctor decide on the most effective treatment plan while avoiding treatments that may not work, may waste time, or may cause harm. Currently, comprehensive biomarker testing should be completed in all advanced or metastatic non-squamous, non-small cell lung cancers, and in many advanced or metastatic squamous cell non-small cell lung cancers. Given the success of targeted therapies in treating metastatic lung cancer, there are also opportunities to use these treatments in earlier stage cancers as well.

Although comprehensive biomarker testing is not currently the norm with earlier stage lung cancers that have been surgically removed, some mutations are currently being tested, and some targeted treatments are being used. I expect that in the future – which may not be too long from now – comprehensive biomarker testing will be a part of all lung cancer diagnoses regardless of type and stage. Until then, it is best to talk with your medical oncologist about comprehensive biomarker testing.

To learn more, I invite you to join the Lung Cancer Initiative for an important educational event on Tuesday, November 16 at 5:30 p.m. – Lung Cancer Treatment & Biomarkers: Make it PersonalThe event is being hosted in Durham, NC at The Solution Center and will also be livestreamed online. To register, visit click here.

- Kathryn Mileham, MD, Atrium Health Levine Cancer Institute, Board of Directors, Lung Cancer Initiative

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