Early Biomarker Testing Key for Perioperative NSCLC Success

Continuing our conversation with Ticiana Leal, MD, here she explains the importance of biomarker testing in the perioperative setting for patients who have early-stage non–small cell lung cancer (NSCLC), and how and why conversations across disciplines and during tumor boards help to align opinions on optimal treatment choices for patients and streamline that decision-making process.

Leal is associate professor and director of the Thoracic Medical Oncology Program in the Department of Hematology and Medical Oncology at Emory University School of Medicine and a board-certified medical oncologist at Winship Cancer Institute.

This transcript has been lightly edited.

Transcript

Why is biomarker testing important when planning perioperative NSCLC treatment?

Biomarker testing is essential. We've seen that it's essential in the advanced setting. We're seeing these trials now in the perioperative and adjuvant space demonstrating that it is critical to perform biomarker testing in patients with early-stage non–small cell lung cancer. And the reason for that is, number 1, I think for patients who have actual driver mutations—and you identify that in that preoperative setting—it may be that you switch the way that you think about what options are available for patients, knowing that for some driver mutations such as EGFR and ALK, where we have approvals of targeted therapy in the adjuvant space and that we know immunotherapy is not as effective, that a new adjuvant or a perioperative chemo-immunotherapy strategy is not going to be the best therapy for this patient and that this patient may go perhaps with preoperative chemo alone and then surgery followed by the adjuvant targeted therapy, or go straight to surgery with a postoperative approach, with chemotherapy and then targeted therapy as well.

I think biomarker testing needs to be done consistently. It does mean that we have to do it early. Some potential barriers can still include turnaround time for biomarker testing, so perhaps here thinking about reflex testing is also an important strategy to sort of optimize and accelerate the results.

What considerations should be top of mind for physicians when considering perioperative NSCLC management?

When we think about perioperative management of patients with early-stage non–small cell lung cancer, I think it's key to highlight the importance here of a multidisciplinary team approach, and the importance of these multidisciplinary tumor boards, because we can, as specialists taking care of patients with lung cancer, talk about these cases, review the imaging, and really make sure that the key specialists that are going to be involved in decision-making are up front seeing patients, and that we align the message of what the best treatment approaches are going to be for patients with early-stage non–small cell lung cancer as we define perioperative approaches with the patients.

It really does require seeing the patients earlier, for a medical oncologist; for example, doing that biomarker testing as early as once we get those biopsy results. And I think it's important that, again, that we align the message that we're conveying to the patient, so that decision-making conversation is streamlined across the different specialists seeing the patients. And I think at Emory what we're trying to do is actually have these multidisciplinary clinics in real time, where we can have that conversation together and hoping that that will improve outcomes, and tracking these results so that we can ensure that we are streamlining these results and outcomes for patients.