Tag Archive for: mutational profile

When Should Lung Cancer Patients Receive Biomarker Testing?

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When Should Lung Cancer Patients Receive Biomarker Testing? from Patient Empowerment Network on Vimeo.

Biomarker testing is vital for non-small cell lung cancer (NSCLC) patients, but when should it happen? Expert Dr. Joshua Sabari from NYU Langone discusses cancer cell mutations and ideal timing for biomarker testing for the best patient care.

Download Resource Guide  | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Biomarkers

Related Resources:

Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

 Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

 Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Transcript:

Lisa Hatfield:

And just from the patient perspective, does a patient need to be tested for these biomarkers throughout the course of their treatment, or is it done initially upon diagnosis or before second-line treatment?

Dr. Joshua Sabari:

Yeah, that’s a great question. You know, most mutations are clonal, meaning that they start in the original cancer cell and then the subsequent cells, daughter or son cells, also have that same mutation. So I would recommend doing next-generation sequencing up front in all patients. Now, some people have a specific mutation that we block with a targeted therapy. It could be pills. It could be an infusional targeted therapy. And that might change the sort of milieu or landscape of that mutational profile. So subsequently, after treatment, you may see acquired resistance or secondary mutations that will prevent the therapies from being effective. In those cases, I do recommend re-profiling.

So the most common example in lung cancer is the EGFR mutation, stands for epidermal growth factor receptor. We know that this mutation occurs in 20 to 25 percent of people diagnosed with non-small cell lung cancer. If you’re matched to a targeted therapy and don’t unfortunately have progression of disease, it may be very helpful to re-biopsy or re-sequence using both tissue and plasma to help us guide subsequent therapy. But if you do not have a targeted mutation and you’re treated with either chemotherapy and immunotherapy or immunotherapy alone, re-biopsy may not be as helpful in matching to further therapy.

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Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

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Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights from Patient Empowerment Network on Vimeo.

How can non-small cell lung cancer (NSCLC) patients be empowered when newly diagnosed? Expert Dr. Joshua Sabari from NYU Langone discusses what he shares about NSCLC incidence rates, histology, and biomarkers with patients and families.

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“…know what type of cancer you have, the histology. Whether it be adenocarcinoma or squamous cancer. And equally as important, know your biomarker, what mutation is driving your cancer and what PD-L1 expression your tumor harbors.”

Download Resource Guide  | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Biomarkers

Related Resources:

Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

 When Should Lung Cancer Patients Receive Biomarker Testing?

When Should Lung Cancer Patients Receive Biomarker Testing?

 Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Transcript:

Lisa Hatfield:

Dr. Sabari, how do you explain non-small cell lung cancer to your patients and their care partners and families?

Dr. Joshua Sabari:

Yeah, so non-small cell lung cancer is a common cancer in the United States. It’s actually the third most common cancer. And really, you know, non-small cell lung cancer makes up multiple different histologies or types of cancer in the lung. The most common being adenocarcinoma, which is probably about 60 percent to 70 percent of non-small cell. We also hear about squamous cell cancer. And what this means is what is the original cell where the cancer arose? So adenocarcinomas occur in gland cells.

Whereas squamous cancers occur in cells such as the lining part of the lung. And it’s important to know what type of cancer you have because these are treated differently. And when you think about non-small cell lung cancer, we said there are many different ways that people can present. Some people can have shortness of breath, cough, you know, and weight loss. Whereas other people may have no symptoms at all.

So again, the important thing here is that lung cancer can be diagnosed in anybody. All you really need to have is lungs. We see lung cancer in people who’ve smoked in the past, but we also see lung cancer in people who’ve never smoked. And that brings me to a really important point. Once we understand the histology, the type of cancer that it is, we then want to understand some of the biomarkers, right? What are biomarkers?

Biomarkers are distinct sort of entities that help us better understand things about your cancer. And allow us to potentially match people to therapies. So two biomarkers that we generally think about, one is molecular or mutational biomarkers. These are the mutations or abnormalities that led to the cancer. Two kinds of mutations. One is a germline mutation, which is inherited from mom and dad and has a risk of being passed on to your children.

These are uncommon in lung cancer. The second type is called a somatic mutation. And these are mutations that are acquired from the environment, from smoking, for example, from pollution, from radon. And these are not generally inherited mutations. So really important to understand mutational profile and ask your doctor, what is my mutation? Because we can then match people to targeted therapies. The second biomarker that is really important is something called PD-L1 or programmed death-ligand 1. I know it sounds exotic.

But that’s a biomarker that helps us guide how likely immunotherapy will work in your cancer. If the PD-L1 expression is high, greater than 50 percent, immunotherapy may be a very good option. If the PD-L1 expression is low, immunotherapy may sometimes be used, but more commonly in combination with chemotherapy. So my activation tip here is know what type of cancer you have, the histology. Whether it be adenocarcinoma or squamous cancer. And equally as important, know your biomarker, what mutation is driving your cancer and what PD-L1 expression your tumor harbors.

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New Developments in MPN Treatment Landscape

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New Developments in MPN Treatment Landscape from Patient Empowerment Network on Vimeo.

For the MPN treatment landscape, what are the latest developments? MPN expert Dr. Claire Harrison from Guy’s and St. Thomas’ Hospital in London shares how the treatment landscape is changing and diagnostic criteria to be published on how each specific diagnosis should be used to optimize care.

See More from Best MPN Care No Matter Where You Live

Related Resources:

What Is in the Treatment Pipeline for Patients With MPNs?

 MPN Treatment Strategies for Patients Who Have Failed Traditional Therapies

 How Can MPN Patients Become More Proactive in Their Care?

Transcript:

Dr. Nicole Rochester: 

Dr. Harrison, we know that the treatment landscape for MPNs is rapidly changing and keeping up with the pace of the developments can be challenging both for healthcare professionals and certainly for patients and their families, so I was wondering if you can give us a general overview of the treatment landscape and maybe highlight anything that’s new and in development that you think would be helpful for the audience.

Dr. Claire Harrison: 

Well, sure, I think this is obviously really interesting, very important. It’s a fast-moving field. And one of the first changes actually completely hot off the press is a brand new diagnostic criteria that has been produced by two separate groups that are shortly about to be published kind of just seeing pre-published and those of us that have been privileged to be involved, have seen them. So that’s going to really focus the mind of clinicians on how do we achieve the diagnosis, and that’s the first thing that’s really important, get an accurate diagnosis, don’t just accept well, you’ve got an MPN, actually, it’s really important to know what type you’ve got. Maybe as much do you tell as possible in terms of the genetic mutation or change that underlies the disease, because that is increasingly important in what we call prognostication, understanding what the risk of events happening due to the disease actually is. 

When we make a diagnosis, we sometimes can’t be accurate, and we might have to go back and revisit them, so some patients don’t get a PV, ET, or MF diagnosis, they might get an MPN unclassified. That’s okay, but it’s important to keep revisiting that. Once we’ve made a diagnosis, then it’s really important to think about what the risk is to the patient, and we’ve had some changes to our risk classifications recently, right from the ET end of the spectrum where we’re thinking more and more actually, those patients who are under the age of 60 with a lower count and the CALR mutation, do we even need to give you aspirin, because we might be increasing the risk of bleeding. 

To the other end of the spectrum for patients with myelofibrosis, a more aggressive disease, we want to know more about your mutational profile, so we’re doing more powerful genomic tests and assessing them your prognosis, and then what the features of your disease are that need treatment. And there are lots of changes, which I think we’ll get into later in our conversation here and lots of new options, which are really important,  I just also don’t to leave this segment without saying to all of you who are listening, it’s important that you understand your disease, it’s important that you understand the diagnosis, prognosis, etcetera, and you get the best care.

But that’s maybe not enough, you need to know that you’re taking good care of you, and that’s something that’s really important to all of us, so you need to know that you’re managing your vascular risk, don’t just think about your blood. Think about the fact that you know if you’re smoking, quit smoking, if you’re drinking too much, cut it down, if you’re not walking enough,  walk more, lose weight. The majority of patients with MPN actually have a problem with a blood clot, not a further complication of their disease, so maybe we’ll stop there and then we can dive in a bit more deeply.