Molecular Genotype Testing May Improve Lung Cancer Outcomes

A recent study showed that undergoing molecular genotyping before receiving first-line treatment resulted in improved survival for patients with non-small cell lung cancer (NSCLC).

Molecular genotyping looks at the genetic makeup of a tumor. Specifically, within NSCLC, molecular genotype testing can reveal genes that contribute to the reason lung cancer grew into the disease.

In an interview with CURE®, Dr. Melina Marmarelis, Penn Medicine Physician, discussed the study further, alongside next steps that are being looked at within the specific patient population.

Q: Why is it beneficial for patients to undergo molecular genotyping?

A: The most obvious reason is that there is information in those testing reports that will actually determine which drug a patient gets. There are specific targets and those in lung cancer, for the most part, those are pills. Some examples of those are specific mutations in genes like EGFR, ALK or ROS1. And if a patient has one of those specific mutations in their tumor, then they're eligible for a targeted therapy, usually in the form of a pill that they take at home, to treat their cancer compared to chemotherapy or immunotherapy, which are different modalities of treatment. It's actually widely disparate, the type of treatment someone might receive, depending on those results.

Q: Are these therapies easily accessible to patients?

A: Even if you find the target, only about 50% of people actually get the appropriate drug. There are a lot of reasons for that probably, there are a lot of barriers, some patients may be too sick for any therapy. Some of the reasons that you're alluding to, in terms of financial barriers, are probably very real as well. These drugs are available and approved in the United States, they are covered by insurance, but there are often are hefty copays for patients. There are patient assistance programs that are relatively good, but actually recently have also undergone some changes that have made it a little bit harder for patients to access these drugs. I think they're still very much as an access problem.

Q: Is there any room for a future study to further help this patient population?

A: Yes, you would need to start with patients who have been diagnosed, and in one group provide a certain type of molecular testing and in the other group, a different type. Of course, this day and age, we would never randomize people to not getting molecular testing, just because it's so important. But there now are various ways that people are approaching this. Some people are doing only the blood test because it will result faster and then trying to do the tissue if they don't get the answers there. I think there certainly are studies that can be done in order to figure out the optimal type of sequencing.

We are focusing on making sure that everybody gets tested. That's the focus of our current trial. We're looking at ways to nudge patient teams, essentially, to make sure that they're getting, in particular, the blood test, since that does give you the results, the fastest is an easy thing for people to do. We believe that doing both the tissue testing and the blood tests at the same time actually gives you a better chance of detecting one of these targets. And alongside patients being eligible for a targeted therapy.

Q: Within this field, what have you seen as the biggest advancement from 2023?

A: The first answer to that is that if you've looked back just at the last 10 years, the approvals for targeted therapies, so these pills, targeting a very specific alteration in lung cancer have just exploded. And that is great news for our patients. Many of these patient populations have multiple pills available to them. Even if the first pill doesn't work, they have a second pill potentially, or another targeted therapy. And so there have been approvals for various different targeted therapies, even this year. I think that that's probably the most straightforward the easiest thing.

There is also a lot of work being done on how to improve access to molecular testing, how to improve access to targeted therapies, and that work has to be done at a bunch of different levels. It's got to be done at the level of the physicians’ level of the patient, the level of the payer, the insurance company and even the level of some of the regulations that are set by the government for the types of tests that can be done.

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