Tag Archive for: PD-L1 expression

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.

[ACT]IVATION TIP

“…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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See More from [ACT]IVATED NSCLC Biomarkers

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 Equity in Action | Addressing Biomarker Disparities in Lung Cancer

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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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What Are Biomarkers and How Do They Impact Lung Cancer Treatment Options?

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What Are Biomarkers and How Do They Impact Lung Cancer Treatment Options? from Patient Empowerment Network on Vimeo.

What are lung cancer biomarkers, and how do they impact treatment options? Dr. Isabel Preeshagul defines biomarkers and explains how different biomarkers may help determine treatment options and aid in predicting treatment response. 

Dr. Isabel Preeshagul is a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center. Learn more about Dr. Preeshagul here.

See More From INSIST! Lung Cancer

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Transcript:

Katherine Banwell:

Well, let’s define a few terms that are often confusing for patients. What are biomarkers?

Dr. Preeshagul:

Those are somatic alterations in the tumor just like EGFR, or ALK fusions, or MET exon 14, or MET amplification, or KRAS G12C.

These are all genes that are altered in the tumor. And these are genes that drive the tumor to grow. There are also other markers like PD-L1, which is a marker for response to immunotherapy. And there are various markers.

I could go on and talk about it for hours, but those are the more common ones that we know how to treat and how to handle and prognosticate.

Katherine Banwell:

And another term that’s sometimes confusing, what is a genetic mutation?

Dr. Preeshagul:

So, for genetic mutations, you have germline, and you have somatic. So, a germline mutation may be something like a BRCA1 or a BRCA2 that we see in patients with breast cancer or prostate cancer versus a somatic mutation which would be EGFR that I had mentioned or ALK fusion. So, germline mutations are the ones that we worry about being heritable.

And somatic mutations are those that are not thought to be heritable but thought to happen spontaneously within the tumor itself and cause the tumor to grow. We are constantly learning more about these though, however. But it’s really important to talk with your doctor to see if you have a germline mutation or a somatic mutation or if you have both.

And it is never wrong to seek an opinion with a genetic counselor to make sure that everyone in your family is safe, that you’re up to date on age-appropriate cancer screening, and that your family gets screened appropriately as well if indicated.

Katherine Banwell:

Are there specific biomarkers that affect lung cancer treatment choices?

Dr. Preeshagul:

Oh, definitely. One that I had mentioned is PD-L1. And this is a marker that we look for expression. So, based on FDA approval for pembrolizumab, if you have an expression of 50 percent or more, you are able to get immunotherapy alone in the upfront setting. If you have less than 50 percent, we often give you chemotherapy plus immunotherapy. And that’s based on a clinical trial known as KEYNOTE-189.

Other markers such as EGFR, as I had mentioned, ALK fusions, RET, NTRK, MET exon 14, ROS1, KRAS, HER2, you name it, those are alterations that we look for ideally in the upfront setting as well and can really affect treatment planning.

And those patients that harbor mutations like EGFR and ALK and ROS1 or MET exon 14, we know that these patients do better with targeted therapy upfront, not standard-of-care chemo. So, it’s really important to know about the presence of these alterations before you start treatment if possible.