Certain mutations in cancer cells are a bullseye for treatment.
In recent years, genomic testing has brought new hope to people with lung cancer, especially those with non-small cell lung cancer. Genomic testing is a molecular analysis of a tumor, where researchers look at cancer cells to see if there are certain mutations that could be linked to the type of cancer you have.
“Genomic testing has significantly changed how lung cancer is treated. In those patients who have activating mutations or changes in the lung cancer cells where we can use targeted therapy, the outcome is significantly better,” says Jorge Gomez, MD, a lung oncologist at Mount Sinai Hospital.
How Genomic Testing Enhances Target Therapy Treatment
Each lung cancer tumor is unique. Genomic testing looks at the DNA and levels of specific proteins present in the tumor to try and identify what’s causing the tumor to grow. “These changes or mutations, which are most common in lung cancer, can be used as a target for treatment,” says Dr. Gomez.
Targeted therapies are a type of treatment that “targets” these mutations directly. Learn more about how targeted therapies treat lung cancer.
The only drawback to targeted therapies, however, is that they can’t help all lung cancer patients. “Genomic testing is most important for patients with non-small cell lung cancer who have a type of cancer called non-squamous carcinoma,” says Dr. Gomez. “For that population of 15 or 20 percent of lung cancer patients, this has changed their life significantly.”
Non-squamous carcinoma is an umbrella term that includes other subtypes of cancer, such as large cell carcinoma and adenocarcinoma. “These are the patients that are most likely to have these mutations and benefit from the testing,” says Dr. Gomez. For example, tumors in more than half of patients with lung adenocarcinoma have been found to have specific mutations, according to Memorial Sloan Kettering Cancer Center.
The best time to talk to your doctor about genomic testing is at a lung cancer diagnosis, before a biopsy is done. This will help ensure that the doctor removes enough tissue during the biopsy to do molecular testing.
Dr. Gomez is a hematologist and oncologist at Mount Sinai Hospital and an assistant professor of Medicine, Hematology, and Medical Oncology at the Icahn School of Medicine at Mount Sinai.
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Genomic testing has significantly
changed how lung cancer is treated.
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In those patents who have activating
mutations or changes in the cancer cells,
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where we can use targeted therapy,
the outcome is significantly better.
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And so for that population of 15 or
20% of lung cancer patients,
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this has changed their life significantly.
00:00:20,778 --> 00:00:25,177
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Genomic testing is testing the DNA of
the cancer cells to see if they have any
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changes or mutations in the cells that may
have led to the production of the cancer.
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These changes or mutations,
which are most common in lung cancer,
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can be used as a target for treatment.
00:00:42,362 --> 00:00:47,278
The difference between targeted
therapies and traditional chemotherapies
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is that targeted therapies really
are going after the specific cause or
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the specific molecule that is abnormal and
producing the cancer.
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Chemotherapies are just designed
to kill cancer cells or
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any cell that's dividing rapidly.
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It's not going specifically to the cancer,
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it's just a toxic drug
that kills any cell.
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Genomic testing is most important in
certain patients with non-small cell lung
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cancer, who have a type of cancer
called non-squamous carcinoma.
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And those are several types of cancers,
large cell, adenocarcinoma,
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those are the patients who are most
likely to have these mutations and
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to benefit from the testing.
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What these mutations do really
is perpetuate the signaling from
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the outside of the cell to
the interior of the cell, and
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many of these signals are signals for
growth and development.
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And so when these molecules are mutated,
they are sometimes turned on.
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And so they continuously signal for
cells to divide,
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go outside of the tumor itself.
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Genomic testing is really
appropriate right now for
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patients with advanced or metastatic
disease, or stage IV lung cancer.
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We are doing clinical trials in patients
with earlier stage of disease and
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patients with locally advanced cancer,
and some patients in the adjuvant or
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postoperative setting in patients
with early stage disease.
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But the results of those
trials are not final, and so
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we tend not to sequence or not to do
genomic sequencing in those patients.
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As a patient,
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it's important to ask whether you're
getting comprehensive genomic testing.
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Because there are some mutations that
while we don't have treatments for
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them immediately, we may be able
to use treatments that are not
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specifically FDA approved for
that indication later in the treatment.
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Personalized, genotype-directed therapy for advanced non-small cell lung cancer. UpToDate. (Accessed on January 18, 2018 at https://www.uptodate.com/contents/personalized-genotype-directed-therapy-for-advanced-non-small-cell-lung-cancer)
Molecular Epidemiology of EGFR and KRAS Mutations in 3026 Lung Adenocarcinomas: Higher Susceptibility of Women to Smoking-related KRAS-mutant Cancers. New York, NY: Memorial Sloan-Kettering Cancer Center, 2012. (Accessed on January 18, 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500422)
Lung Cancer Tumor Testing. American Lung Association. (Accessed on January 18, 2018 at http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/learn-about-lung-cancer/how-is-lung-cancer-diagnosed/lung-cancer-tumor-testing.html)
Lung Cancer Genomic Testing (EGFR, KRAS, ALK). New York, NY: Memorial Sloan-Kettering Cancer Center, 2012. (Accessed on January 18, 2018 at https://www.mskcc.org/cancer-care/types/lung/diagnosis/genetic-testing)
Genomic Testing in Lung Cancer: Past, Present, and Future. Marseille, France: Multidisciplinary Oncology and Therapeutic Innovations, Hôpital Nord, Chemin des Bourrely. (Accessed on January 18, 2018 at http://www.jnccn.org/content/16/3/323.abstract)