At the 22nd Annual Conference of the National Comprehensive Cancer Network, held March 23-25, 2017, in Orlando, FL, Gregory J. Riely, MD, PhD, Memorial Sloan Kettering Cancer Center, spoke about the what, when, and how of biomarker testing in non-small cell lung cancer.
At the 22nd Annual Conference of the National Comprehensive Cancer Network (NCCN), held March 23-25, 2017, in Orlando, Florida, Gregory J. Riely, MD, PhD, Memorial Sloan Kettering Cancer Center, spoke about the what, when, and how of biomarker testing in non-small cell lung cancer.
Biomarker testing is essential in lung cancer, Riely said, and should be done at diagnosis. “Even if it is not done at diagnosis, testing before the choice of second-line therapy is valuable as well.”
Riley showed the scanned image of the lungs of a woman who presented with an adenocarcinoma. Diagnosis of an adenocarcinoma may not be as bad as it was a decade ago, he said, adding, “We need to identify biomarkers for this, which, today, can start with molecular analysis and PD-L1 testing.”
Based on the results of the molecular analysis, the patient may receive:
“Current NCCN Guidelines for a patient who presents with metastatic disease recommend molecular testing to establish histologic subtype, smoking cessation counseling, and palliative care. For all the various histological subtypes, molecular testing is central,” Riley said. The key thing is to conduct these tests as part of a broad molecular testing profile. An important consideration is multiplexing to be able to maximize on the small biopsy sample.
fluorescence in situ hybridization, known as FISH
Molecular testing for lung cancer has focused on DNA-based tests like sequencing and . But over the last few years, protein tests have grown in usage, primarily immunohistochemistry.
Riley then shared phase 3 results from the KEYNOTE-024 trial that were presented at the annual meeting of the European Society for Medical Oncology last year and published in the New England Journal of Medicine, which showed that pembrolizumab was effective in advanced lung cancer, compared with platinum-based chemotherapy, when PD-L1 was expressed in at least 50% of tumor cells.
“However, PD-L1 tests are all over the map, so how do you choose?” asked Riley. The fact that each PD-1 inhibitor introduced and approved has developed a complementary assay to test PD-L1 expression in the tumor samples makes it challenging to figure out how all these tests compare.
A recently published study in JAMA Oncology compared 4 such PD-L1 assays, and found that while the tests were analytically interchangeable, they had not been cross validated. Further, only 3 of the 4 assays were concordant and reproducible.
An important point that Riley noted during his presentation was that PD-L1 expression is probably stable and there is no clear benefit to repeat a biopsy unless the prior sample is exhausted.
It’s also important, to customize biomarker testing needs based on the institution.
“Often, institutions use a combination of tactics to achieve comprehensive evaluation in a timely manner,” Riley said.
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More
Government agencies have created an online portal for the public to report potential anticompetitive practices in health care; there are changes coming to the “boxed warning” section for chimeric antigen receptor T-cell therapies (CAR T) to highlight T-cell blood cancer risk; questions about the safety of obesity medications during pregnancy have arisen in women on them who previously struggled with fertility issues.
Read More
Oncology Onward: A Conversation With Penn Medicine's Dr Justin Bekelman
December 19th 2023Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.
Listen
Gene, Light Therapy Combo Shows Promise Against Prostate Cancer Cells in Proof-of-Concept Study
April 18th 2024In their preclinical model, the researchers found efficacy both in vitro and in vivo by using CRISPR-Cas9 to mimic porphyria and combining the technology with light therapy.
Read More
Pegcetacoplan for PNH More Cost-Effective Than Anti-C5 Monoclonal Antibodies
April 18th 2024A cost-utility analysis conducted from the perspective of the Italian health system found that pegcetacoplan was more effective and less costly than 2 complement 5 (C5) inhibitors for the treatment of paroxysmal nocturnal hemoglobinuria (PNH).
Read More