Daniel Saez, treatment and trials navigator at the GO2 Foundation for Lung Cancer, discusses biomarker testing and precision medicine in lung cancer.
Kristie L. Kahl: Can you explain what biomarker testing is?
Daniel Saez: Biomarker testing is a genetic test to determine what mutations within the cells of a tumor are causing it to grow. So one way to think of it is like, if your cells and your body is a script of a play, a genetic mutation would be an error or a typo within a line in that play. And that type can either have no effect, or a really big effect. And that effect might cause a cancer to grow. So biomarker testing is trying to identify those typos within the scripts of your body.
Kristie L. Kahl: How does this play a role in the treatment decision for patients?
Daniel Saez: Biomarker testing plays a huge role in treatment for many cancer patients. Targeted therapies can only be given if a patient has an identified biomarker. Targeted therapies are a drug that targets only the changes that are causing the cancer. In lieu of that, targeted therapies have been shown to be much more effective than chemotherapy for patients who have an applicable biomarker. So getting biomarker testing is the only way to receive what could be the best treatment for many patients.
Kristie L. Kahl: Can you give some examples of the currently approved targeted therapies in lung cancer?
Daniel Saez: In lung cancer specifically, there's targeted therapies for many different biomarkers. Those include EGFR, MET, RET, ROS1, ALK and KRAS. Also, there are a lot of clinical trials for other targeted therapies and different targeted therapies within the different biomarkers themselves.
Kristie L. Kahl: Who should get biomarker testing or who should ask for it?
Daniel Saez: At this point, any non-small cell lung cancer patient should be asking for biomarker testing. There are approved targeted therapies for many stages for patients that have a specific biomarker. And early stage EGFR-positive patients have an improved targeted therapy in the form of Tagrisso (osimertinib). There are clinical trials for early stage patients that are not EGFR positive, so even they should be getting biomarker testing.
Kristie L. Kahl: If a patient has a doctor that hasn't mentioned biomarker testing, should they bring it up? And how can they go about doing that?
Daniel Saez: That's a great question. So many times the doctor will perform the biomarker testing at diagnosis, without really telling the patient about it ahead of time, they just do it as part of the examination. First thing that I advise patients about is to have the conversation whether they've had the testing or not. They may have had it and they just didn't have that communication. Their physician didn't tell them about the testing, then is the time to ask for the results and to ask for them to be explained to you because an educated and empowered patient is one that makes good decisions.
If it turns out the patient has not received the biomarker testing, then it comes to asking why there may be a good reason. Many physicians are not comfortable ordering biomarker testing for a patient that is early stage that may not have a biomarker because it would be hard to get that reimbursed. For patients that are still interested in getting biomarker testing and their physician doesn't give them a great reason why not, then they can start seeking either second opinions without testing or ask to be sent out of house to a testing lab.