Real-world Lung Cancer Testing Rates Are Lower Than They Should Be, Says Dr Ticiana Leal

Biomarker testing should be done on all patients with an initial diagnosis of advanced nonsquamous non–small cell lung cancer, but the testing rates in the real world are lower than they should be, particularly for underserved or minority populations, said Ticiana Leal, MD, associate professor, director of the Thoracic Medical Oncology Program, Department of Hematology and Medical Oncology, Emory University School of Medicine.

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What is the real-world utilization of biomarker testing in patients with lung cancer?

Biomarker testing is essential and is recommended for all patients with new diagnosis of nonsquamous non–small cell lung cancer in the stage IV setting. I think the real-world testing rates are lower than they should be. Looking at different studies, you see anywhere from 50% to 60% of patients are receiving adequate testing, and that number may be even lower for populations that are underserved or minority populations.

Are there certain patients with lung cancer who are better candidates for biomarker testing? Are there certain biomarkers that should be tested for first?

I think the reality of it is: for biomarker testing, this should be done for all patients with initial diagnosis of advanced nonsquamous non–small cell lung cancer. In the beginning, we thought that perhaps there were clinical characteristics that might enrich for certain biomarkers, but the more we test, and certainly the number of actionable targets are really increasing. So, it really should be sort of an all-comer population with advanced nonsquamous non–small cell lung cancer.

The way that testing has evolved, it has really evolved from doing single gene testing in a sequential fashion, to try to really do a more broad-based testing all at once with, for example, next-generation sequencing. That can be done with tumor tissue testing, which has been our gold standard. But now we are increasingly incorporating liquid biopsy where you can do next-generation sequencing with liquid biopsy, looking at circulating tumor DNA, and also get really accurate and concordant results with tumor tissue as well.