One of the most important reasons for the recent improvements in lung cancer treatments is biomarker testing — testing to determine the exact kind of cancer a patient has, in order to enable the most personalized treatment possible.
For many patients, a lung cancer diagnosis comes as a surprise. Lung cancer remains the most deadly form of cancer, according to the National Cancer Institute.
Yet, in the past two decades, Dr. Stephen Liu, director of Thoracic Oncology and Developmental Therapeutics at Georgetown University’s Lombardi Cancer Center, said knowing as much as possible about a patient’s specific cancer can greatly affect treatment’s effectiveness.
“Within lung cancer, there are dozens of different types of cancer,” Liu said. “And we now have personalized treatments that are tailored to those types of cancers.”
Lung cancer biomarker testing, which is also known as tumor testing, genetic mutation testing, next-generation sequencing (NGS) or genomic testing, looks for changes in the DNA of tumor cells.
“And it is absolutely essential in choosing the right therapy,” said Liu, since a growing number of mutations have targeted therapies available.”
“These tend to be oral medications, taken once or twice a day, and while they have their share of side effects, they’re generally and consistently, much better tolerated than chemotherapy,” which affects both cancerous and healthy tissue.
Liu, who co-hosts the “Lung Cancer Considered” podcast that is produced by the International Association for the Study of Lung Cancer (IASLC), said the effectiveness of targeted therapy is dramatic.
“More effective than chemotherapy, we can see immediate responses, sometimes within days, but only if we get it right” through biomarker testing, Liu said. “Close doesn’t count. We need to match this perfectly.”
Often, biomarker testing doesn’t begin until after a patient has been diagnosed with lung cancer, which coincides with CT scans and brain MRIs, to determine whether the newly diagnosed cancer had already spread.
Liu said it is important for an oncology team to gather all test results before beginning treatment.
“It’s very common for there to be this urgency to begin therapy — completely understandable,” said Liu. “You get the sense that this cancer has some momentum, and you want to start treatment, yesterday.”
While waiting for test results can be frustrating for a newly-diagnosed patient, Liu said biomarker testing is important.
“I’m not looking for the fastest treatment,” Liu said. “We’re looking for the right treatment.”
Despite the importance of biomarker testing, Liu said surveys show a surprising number of doctors, even oncologists, aren’t aware of its value.
“I think we’ve moved past this paternalistic era, where the doctor knows everything,” Liu said. “In oncology, even within the world of lung cancer, things move at a pace we’ve never seen before.”
Still, given the dramatic improvements in the effectiveness and relatively gentle side effects of targeted therapy, and its reliance on biomarker testing, Liu hopes patients will feel empowered to ensure they’re tested.
“There’s no harm at all in asking your doctor, ‘What biomarker tests were done, and what were the results of those tests?'” Liu said. “I will tell you, if a doctor is threatened by someone asking a question, I think you really need to reconsider that relationship.”
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