Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 11Algorithm for mutation testing in metastatic nonsquamous NSCLC
2:11 minutes.
TRANSCRIPTION:
DR BLUMENSCHEIN: It depends on how much tissue they have. And I do have a hierarchy, an algorithm that I like to go through. Generally, we’ll test in our MDL about 50 different genes. But in terms of what will come first if there’s a paucity of tissue, I look at ALK and ROS1 because if that’s the only way to get those drugs, you have to be positive, then EGFR after that. But I think, all things being equal, I test for the usual 50-gene panel. We like to get core biopsies so we have adequate tissue. And again, we talked about the circulating free DNA that we also send off. But if a patient comes to see me — they’re doing well — we’ll talk about getting molecular profiling. And it’s going to depend on where they are in terms of their symptoms and the level of anxiety with their diagnosis. Some patients want to wait to find out what their molecular profiling is. And if they look clinically like that’s an appropriate thing, then we’ll do so. It usually takes about a month to get all that information back. And then if we have something, we start to treat them with, say, an EGFR inhibitor if they’re an EGFR mutation-positive patient. For those patients who are symptomatic from their disease, I’ll still send those things off for analysis, but I’ll go ahead and initiate chemotherapy. And if something is positive later on, then I know I can utilize that as a second-line option. DR LOVE: Again, for an oncologist in general practice, from your point of view, in a patient, again with metastatic nonsquamous cancer who does not have EGFR, ALK and ROS1, do you think that they should routinely have some type of multiplex testing sent? DR BLUMENSCHEIN: I do think everyone should have an NGS — would be a preferred approach. I think patients should do both serum and, if tissue’s available, do NGS. Realizing that in a community practice if they’re ROS1-negative, ALK-negative and EGFR-negative, there are not other approved drugs for other targets, but we're getting data now with RET and there’s data coming out for BRAF. So identifying those, I think, are important. |