Dr Mark Socinski: In NSCLC, Biomarker Testing Is Key to Treating Patients Properly

Mark A. Socinski, MD, executive director of the AdventHealth Cancer Institute, discusses the importance of biomarker testing in non–small cell lung cancer (NSCLC).

Transcript

Can you discuss the importance of biomarker testing for patients diagnosed with NSCLC?

As I say to my patients, cancer is a disease of your DNA, and you need to interrogate the DNA to see what secrets it might give up. Now in non–small cell lung cancer, we have—I forget whether it's 9 or 10, but in that range—9 or 10 biomarkers in which the FDA has approved therapies. And the reason these therapies are approved is because, in general, they're better than existing therapies, and they're better than standard chemotherapy.

Many of these patients that have these genomic alterations are not the type of patient that gets a great benefit from immunotherapy, so standard chemotherapy is not the best option to pursue for these sorts of patients. And you can't tell by looking at the cancer whether or not it has a mutation or a fusion that's going to be important. So, you have to do comprehensive testing. You have to kind of check off each of the 9 or 10 biomarkers, including PD-L1—check them all off so you know, at the time of diagnosis, what the optimal treatment is for the patient.

Ideally, and I think we're in an era now where in the vast, vast majority, if not all patients, one has time to wait for the results of genomic testing before you make your treatment decision. As I say to my patients, I want to make sure—because the biggest impact we have in treating the disease is what we do first. So, as I say to my patients, I want to be absolutely sure that your first treatment is going to be the best treatment for your lung cancer.

In order to do that, I need to know the results of the genomic testing. And I need to know the results of the PD-L1 testing and then I can make my recommendation in terms of what's the best treatment. So that's really the importance of comprehensive genomic testing at the time of initial diagnosis. And this really applies for the advanced stage for patient. We don't yet know the role in early stage patients, although we do have an indication for both immunotherapy and an EGFR-directed therapy in the earlier stages of disease. So there are some biomarkers that are important there in the early stages, too.