5 Questions to Ask Your Doctor About Genomic Testing for NSCLC
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How Genomic Testing Is Revolutionizing Cancer Treatment
Bernard Park, MD, a thoracic surgeon and deputy chief of clinical affairs at Memorial Sloan Kettering Cancer Center (MSK) in New York City, says genomic testing is becoming the standard of care (meaning the standard to which all doctors and hospitals should adhere). According to Dr. Park, there are a lot of studies now showing that therapy targeting a mutation is just as good as traditional chemotherapy, but with a greater quality of life.
A review found that precision treatment for NSCLC with targetable mutations increased overall patient survival. And an article in JCO Oncology found that people whose treatment plans were based on molecular testing had a longer time between treatments and improved survival rates, compared with those who received treatment without molecular testing.
While genomic testing was previously done only in people with stage 4 cancer, there has been a concerted shift in recent years to check in earlier stages to allow for 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 4 metastatic lung cancer patients, but now we have a drug approved for patients … who have early stage lung cancer,” says Vamsidhar Velcheti, MD, director of thoracic medical oncology at NYU Langone Health’s Perlmutter Cancer Center in New York City.
People who had early stage lung cancer (stage 1 or 2) typically had surgery and chemotherapy, which was the standard of care, says Dr. Velcheti. “The role of targeted therapy for somebody who, say, has the EGFR mutation and stage 1 or 2 lung cancer was less defined. And, in fact, there were no drugs approved in that setting,” he explains. “In [recent years], we had a drug approved by the [U.S. Food and Drug Administration] for use in patients who have stage 1 or 2 lung cancer and 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 success. “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 is “fast-tracking a lot of this research,” he says, 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 MSK. But if you are not offered genomic testing at your treatment center, you should ask for it, according to the Lung Cancer Foundation of America. The organization stresses the importance of comprehensive molecular profiling of lung cancer tissue.
Questions to Ask Your Doctor
Genomic testing can help determine which therapies may be most effective for you, as well as help you and your doctor make informed treatment decisions. Here are some questions you may want to ask your doctor about this advancement in treatment.
1. When Should I Get Genomic Testing?
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 want to consider getting another biopsy or a liquid biopsy, which is done using blood and other bodily fluids. It 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’s treatable.
2. What Happens Once You Identify My Mutation?
Based on which mutation is identified, there may be an approved targeted therapy that can help with your specific tumor, according to MSK. Or there may be a clinical trial you can enroll in to test a new drug for the mutation.
According to the JCO Oncology article, approximately 50 percent of patients with advanced NSCLC will be have a DNA mutation identified as primarily responsible for the cancer. This mutation can be found with genomic testing and treated with targeted therapies.
3. What Do My Results Tell You About My Treatment Options?
There may be an approved targeted therapy for the specific mutations in your tumor, according to MSK. 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. It can also inform other treatment decisions, including surgery or radiation therapy.
4. 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.
5. How Can These Tailored Treatments Affect My Prognosis?
Your prognosis and life expectancy will depend on a number of factors, including the current stage of your NSCLC. 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 determine your NSCLC treatment.
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