Do lung cancer patients need molecular profiling?

For some patients with non-small lung cancer, chemotherapy isn’t the most effective treatment option. But based on a tumor’s molecular profile or biomarker testing results, lung cancer treatment can be customized to target the tumor’s unique cellular characteristics.

We talked with Anne Tsao, M.D., to understand what non-small cell lung cancer patients should know about molecular profiling, including what tests they may need and when they should receive them.

Here’s what she shared.

How does genetic testing help guide lung cancer treatment?

The molecular abnormalities of a cancer – such as changes in its DNA, RNA and proteins – are what drive its growth. New treatments like targeted therapy and immunotherapy can attack these abnormalities to slow or stop a cancer’s growth. By knowing a tumor’s genetic makeup, we’re better able to predict which treatment is going to be most effective for each patient.

Common genetic mutations seen in lung cancer are EGFR, RET, MET, BRAF and ALK. If we find one of these, we may offer a patient a targeted therapy.

If a patient has high expression of PD-L1 protein on the surface of their cancer cells, a type of immunotherapy called immune checkpoint inhibitors may be an option.

Because they’re more precise, these treatments are usually more effective and have less risk to normal tissue when compared with chemotherapy. Patients tend to experience fewer side effects than with chemotherapy.

What genetic tests should lung cancer patients receive?

At MD Anderson, we look at a patient’s genetic sequencing, and the results from a fluorescence in situ hybridization test, commonly called FISH. We also look at proteins on the tumor cells and stroma with immunohistochemistry. These tests help us understand the order of a patient’s DNA, chromosome rearrangements and the proteins on the tumors’ cells. Together, these can help up identify the most effective treatment.

Which lung cancer patients should receive molecular profiling?

It’s especially important that lung cancer patients who’ve never smoked undergo molecular profiling, but I would advocate that all lung cancer patients should have biomarker testing. 30% of lung cancer cases can be more effectively treated with targeted therapies versus standard chemotherapy, and if you’re in that 30%, it can make a dramatic difference in survival times and quality of life.

When should a lung cancer patient receive molecular profiling?

It can be done at initial biopsy or at the time of surgery. Also, any time there’s a shift or a progression of the disease, patients should undergo biomarker testing again because there may be new targets we can go after.

How is molecular profiling done, and how long does it take?

Testing can be done in two ways. First, we can do a biopsy where we remove tissue from your lungs to be tested. Another approach is called a liquid biopsy. Through a blood draw, we’re able to detect the cancer’s abnormalities. It takes about three to four weeks to get the results of a tissue biopsy, and liquid biopsy results take about two to three weeks.

Sometimes a tissue biopsy approach called fine needle aspiration doesn’t collect not enough tissue to successfully profile a tumor’s genetic make-up. Be sure to tell your doctor that you’d like to receive molecular profiling so that they know the best approach to take with your biopsy.

Why is it important to get molecular profiling at specialized cancer center like MD Anderson?

There are many benefits to seeking care at a specialized cancer center. To start, you’ll receive care from experts with extensive experience in treating your specific type of cancer. At MD Anderson, we have a team of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and interventional pulmonologists that focus just on lung cancer. It’s all we treat -- all day, every day.

It will also grant you access to the most cutting-edge technology and treatments. For example, we conduct molecular profiling in-house, so there are no delays in sending your tumor specimen out for biomarker testing. These results take less time, and they’re reliable.

Also, a cancer center that performs research will give you access to clinical trials, which can sometimes offer the best treatment approach for your diagnosis, especially if you carry a known genetic mutation or biomarker.

Even your earliest decisions, such as whether to receive a biopsy or start chemotherapy, can influence which treatment options are available to you. So, trusting your care to a specialized cancer center from the start can help ensure the best results.

What’s your advice for someone newly diagnosed with lung cancer?

Don’t feel rushed or pressured to start treatment. A single chemotherapy infusion can alter your targeted treatment options – and sometimes make you ineligible for certain clinical trials. So, know that it’s OK to wait to have molecular profiling done.

You’ll have the best chance for successful treatment if you take the time to undergo molecular profiling before starting treatment. I encourage you to seek out a specialized cancer center like MD Anderson that has the resources to conduct the tests – and do so quickly. That way, you and your doctors can get the insights needed to make the best treatment decisions for your specific diagnosis.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.