Cancer is caused by changes, or mutations, in genes, particularly those that control cell growth and division or are responsible for repairing damaged DNA. Genomic testing examines tumor tissue for these mutations and can often tell your doctor which mutation is responsible for your NSCLC and how it can best be treated. For example, some NSCLC cases are linked to a mutation to the EGFR gene, which is involved in making receptor proteins in the body. Lung cancers with EGFR mutations respond to treatments that target these overactive proteins. (Other NSCLC cases are associated with mutations in the KRAS, ALK and ROS1 genes, among others.) If testing reveals a mutation, you might be offered a personalized treatment that targets the specific mutation causing your tumor to grow. This may be as simple as taking a pill with fewer side effects rather than chemotherapy, which was the main option doctors previously had to treat cancer. The results are often dramatic in people with metastatic disease (cancer that has spread). “No one is really cured, but people… who would have been living less than a year are living 5 years, 10 years,” says Roy Herbst, MD, chief of medical oncology at Yale Cancer Center in New Haven, Connecticut. While genomic testing was previously done only in people with stage IV cancer, there has been a concerted shift in recent years to check in the earlier stages to provide targeted treatments that can extend quantity and quality of life. Even just a few years ago, “We’d only be using targeted therapy for stage IV metastatic lung cancer patients, but now we have a drug approved for patients… who have early stage lung cancer,” says Vamsi Velcheti, MD, director of thoracic medical oncology at NYU Langone’s Perlmutter Cancer Center in New York City. People who had early stage lung cancer (stage I or II) typically had surgery and chemotherapy, and that was the standard of care, says Dr. Velcheti. “The role of targeted therapy for somebody who, say, has the EGFR mutation and stage I or II lung cancer was less defined, and in fact, there were no drugs approved in that setting,” he explains. “In the last year, we had a drug approved by the FDA for use in patients who have stage I or II lung cancer who have the EGFR mutation.” Calling this a “major paradigm shift,” Velcheti notes that even for patients who have surgical options for their lung cancer, biomarker testing plays an important role in optimizing treatment and maximizing the chances of it being successful. “We have developed treatments for early stage cancers, both targeted therapy and immunotherapy, to increase chances of a cure,” says Velcheti. In the future, it will become easier, faster, and cheaper to scan for more and more mutations related to NSCLC, Park says. And here’s more good news: The National Cancer Institute, he says, is “fast-tracking a lot of this research” because the medications are so effective. Genomic testing is a routine part of diagnosis and staging for people with NSCLC at some cancer centers, according to MSKCC. But if you are not offered genomic testing at your treatment center, you should ask for it, advises the Lung Cancer Foundation of America, which stresses the importance of comprehensive molecular profiling of your lung cancer tissue.
Questions to Ask Your Doctor
Genomic testing can help determine which therapies may be most effective for you and help you and your doctor make informed treatment decisions. Here are some questions you may want to ask your doctor about this new advancement in treatment.
When should I get my genomic test? It’s best to talk with your doctor about genomic testing before the original biopsy is done to ensure they get enough tissue to allow for the extra testing, according to the American Lung Association (ALA). (If you’ve already had the biopsy and it wasn’t tested, ask your doctor if there is any leftover tissue that can be tested. You may also consider getting another biopsy or a “liquid biopsy,” or blood test, which can also identify some biomarkers, according to the ALA.) If you have NSCLC, your doctor should order comprehensive testing that searches for many potential mutations, not just one or two, to see if you have one that can be treated.What happens once you identify my mutations? Based on which mutations are identified, there may be an approved targeted therapy that can help with your specific tumor, according to MSKCC. Or there may be a clinical trial you can enroll in that is testing a new drug for the mutation.What do my test results tell you about my treatment options? There may be an approved targeted therapy for the specific mutations in your tumor, according to MSKCC. Even if your test results don’t qualify you for targeted treatment, genetic information about your tumor can help your doctor predict the chances that your cancer will return and make other treatment decisions about surgery or radiation therapy.Are there clinical trials available to me? There may be a clinical trial you can enroll in that is testing a new drug for your particular mutation.How can these tailored treatments affect my prognosis? Your prognosis and life expectancy will depend on a number of factors, including what stage your NSCLC is at currently. As an example, targeted therapies for EGFR mutations can extend life by two years or longer.
Talk to your doctor about genomic testing and how it can help inform your NSCLC treatment.
