Targetable Mutations in NSCLC: More Testing Needed!

Diagnosis of adenocarcinoma of the lung, a major subtype of non-small lung cancer (NSCLC), nowadays triggers mandatory testing of tumor tissue for alterations in four genes: EGFR, ALK, ROS1, and more recently, BRAF. If present, these alterations predict sensitivity to specific targeted drugs approved by the U.S. Food and Drug Administration (FDA) that work better and often longer than standard chemotherapy, and are better tolerated.

However, there are many more targetable/actionable genomic alterations (also known as “drivers”) in NSCLC. This blog post will briefly discuss most of them, with the goal of promoting molecular testing for more than the four “usual suspects” mentioned above. Some patients with these alterations may benefit from FDA-approved drugs or from enrollment in clinical trials that are testing additional drugs and drug combinations. Continue reading…

EML4-ALK Fusion Testing, Targeted Crizotinib Treatment Not Cost-Effective in NSCLC

“EML4-ALK fusion testing to identify patients with advanced non–small cell lung cancer eligible for first-line, targeted treatment with crizotinib may not be cost-effective, according to study results.

“Researchers in Ontario used a Markov model to compare the cost-effectiveness of two treatment approaches for patients with stage IV nonsquamous NSCLC. One approach consisted of molecular screening and targeted treatment with crizotinib (Xalkori, Pfizer). The other approach consisted of standard care, which included platinum doublet (cisplatin and gemcitabine) as first-line therapy, second-line pemetrexed (Alimta, Eli Lilly) and third-line erlotinib (Tarceva; Genentech, Astellas Pharma).”

Editor’s Note: Molecular testing can be used to identify genetic mutations in a patient’s tumor that may point to the use of a certain treatment, personalized for him or her. This study explores the costs associated with these treatments. Of course, every patient’s treatment decisions will be made for his or her own personal reasons. You can talk to your doctor to find out if molecular testing and targeted therapies are good choices for you.

The Cancer Biomarker Problem

In 2008, Dr. Charles Sawyers, currently the president of American Association for Cancer Research, wrote an article for the journal Nature entitled: ‘The Cancer Biomarker Problem.’ This excellent paper clearly explains what cancer biomarkers are, outlines the different categories of biomarkers, and emphasizes how important biomarkers are in the field of targeted therapies. Predictive biomarkers are indispensable tools that should direct the rational use of targeted drugs in cancer patients. There are additional types of biomarkers, including some that could help evaluate the course of cancer progression or help determine the effective dose of an investigational drug. But this post focuses on predictive biomarkers. Continue reading…

A Clinical Model for Identifying Radiosensitive Tumor Genotypes in Non-Small Cell Lung Cancer

“We examined clinical outcomes after Gamma Knife (GK) radiotherapy for NSCLC intracranial metastases to evaluate the utility of this model for determining radiosensitive tumor genotypes. This study suggests that EGFR kinase domain mutations and EML4-ALK translocations are radiosensitive NSCLC genotypes, and proposes a novel model to identify radiosensitive subtypes of NSCLC.”