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Future perspective for the application of predictive biomarker testing in advanced stage non-small cell lung cancer.

ABSTRACT: For patients with advanced stage non-small cell lung cancer (NSCLC), treatment strategies have changed significantly due to the introduction of targeted therapies and immunotherapy. In the last few years, we have seen an explosive growth of newly introduced targeted therapies in oncology and this development is expected to continue in the future. Besides primary targetable aberrations, emerging diagnostic biomarkers also include relevant co-occurring mutations and resistance mechanisms involved in disease progression, that have impact on optimal treatment management. To accommodate testing of pending biomarkers, it is necessary to establish routine large-panel next-generation sequencing (NGS) for all patients with advanced stage NSCLC. For cost-effectiveness and accessibility, it is recommended to implement predictive molecular testing using large-panel NGS in a dedicated, centralized expert laboratory within a regional oncology network. The central molecular testing center should host a regional Molecular Tumor Board and function as a hub for interpretation of rare and complex testing results and clinical decision-making.

SUBMITTER: de Jager VD

PROVIDER: S-EPMC10928270 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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Future perspective for the application of predictive biomarker testing in advanced stage non-small cell lung cancer.

de Jager Vincent D VD Timens Wim W Bayle Arnaud A Botling Johan J Brcic Luka L Büttner Reinhard R Fernandes Maria Gabriela O MGO Havel Libor L Hochmair Maximilian M Hofman Paul P Janssens Annelies A van Kempen Léon L Kern Izidor I Machado José Carlos JC Mohorčič Katja K Popat Sanjay S Ryška Aleš A Wolf Jürgen J Schuuring Ed E van der Wekken Anthonie J AJ

The Lancet regional health. Europe 20240301

For patients with advanced stage non-small cell lung cancer (NSCLC), treatment strategies have changed significantly due to the introduction of targeted therapies and immunotherapy. In the last few years, we have seen an explosive growth of newly introduced targeted therapies in oncology and this development is expected to continue in the future. Besides primary targetable aberrations, emerging diagnostic biomarkers also include relevant co-occurring mutations and resistance mechanisms involved ...[more]

PMID: 38476751

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Project description:BackgroundTargeted therapies for advanced non-small cell lung cancer (NSCLC) with oncogenic drivers have caused a paradigm shift in care. Biomarker testing is needed to assess eligibility for these therapies. Pulmonologists often perform bronchoscopy, providing tissue for both pathologic diagnosis and biomarker analysis. We performed this survey to define the existing knowledge and practices regarding the pulmonologists' role in biomarker testing for advanced NSCLC.Research questionWhat is the current knowledge and practice of pulmonologists regarding biomarker testing and targeted therapies in advanced NSCLC?Study design and methodsThis cross-sectional study was performed using an electronic survey of a random sample of 7,238 pulmonologists. Questions focused on diagnostic steps and biomarker analyses for NSCLC.ResultsA total of 453 pulmonologists responded. Respondents vary by reported lung cancer patient volume, ranging from 51% evaluating one to four new cases per month to 19% evaluating > 10 cases per month. Interventional training, academic practice setting, and higher volume of endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) were associated with increased knowledge of practice guidelines for the number of recommended passes during EBUS-TBNA (P < .05). Academic pulmonologists more commonly performed or referred for EBUS-TBNA than community pulmonologists (96% and 83%, respectively; P < .0005). Higher testing rates were associated with interventional training, academic setting, and the presence of an institutional policy, whereas lower testing rates were associated with general pulmonologists, practice in community settings, and lack of a guiding institutional policy (P < .05).InterpretationSubstantial differences among pulmonologists' evaluation of advanced NSCLC, variation in knowledge of available biomarkers and the importance of targeted therapies, and differences in institutional coordination likely lead to underutilization of biomarker testing. Interventional training appears to drive improved knowledge and practice for biomarker testing more than practice setting. Improvements are needed in tissue acquisition and interdisciplinary coordination to ensure universal and comprehensive testing for eligible patients.

Dataset Information

Future perspective for the application of predictive biomarker testing in advanced stage non-small cell lung cancer.

Publications

Future perspective for the application of predictive biomarker testing in advanced stage non-small cell lung cancer.

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