Treatment of lung cancer is far more complex and effective than it was years ago, thanks, in part, to molecular testing strategies that are shaping the realm of personalized care.
“Their care has not just become a single stage-and-diagnosis conversation, but in fact it’s now and ongoing conversation about molecular testing, repeat molecular testing, and ultimately new treatments as they come along,” said Alain C. Borczuk, MD, a professor of anatomic pathology at Weill Cornell Medicine in New York City.
The advent of liquid biopsies has been a huge advance in the lung cancer space, and for pathologists like Borczuk, the method is particularly helpful in making tumor tissue more usable.
“In the role that [liquid biopsies] have now, it has a huge role for me because it does potentially extend the ability to use that tissue,” he said. “If certain alterations are found on liquid biopsies, I can focus on the alterations that can only be determined by the tissue right now.”
From the patient and provider perspective, liquid biopsies may also be an easier, less threatening approach to testing, since they use a blood sample to measure tumor DNA. Conversely, more traditional tissue biopsies use a portion of the actual tumor.
However, the sensitivity of this procedure still needs to be better defined, according to Borczuk.
“The role of liquid biopsies is still to be defined in that it has its own profile in terms of sensitivity, especially of the tests,” he said.
Regardless of the method of molecular testing, it is paramount that healthcare providers have open communication with one another, including the physicians who order the tests, the providers who collect the sample, and pathologists.
Pathologists can help guide other providers in collecting an adequate sample.
“We need to make sure that they know what that kind of sample really looks like, so they can provide it,” Borczuk said. “They need feedback for when the samples are not adequate. That is a huge problem that has been recognized in the field.”
On the pathologist side of things, Borczuk mentioned that they need to improve mechanisms so that they do not waste the tissue that they receive—especially as it may become important as more advancements are made in the field.
“We recognize it as a precious commodity, not just for diagnosis, but for all the testing that needs to be done today, and potentially with new discoveries coming so frequently, testing that may need to be in 6 months, a year, or 3 years,” he said.
These future advancements can include the expansion of defined alterations in lung cancer, along with the drugs that can target them. But to do that institutions across the nation must come together to categorize samples, Borczuk said.
“This is still an ongoing process, and we need to do it in a more coordinated way in every patient in every indication so that we have the data that we need to truly find which alteration is the best for that patient,” he said. “This is not an exercise of hundreds or thousands of patients, but as we’ve seen in breast cancer, we need 10,000 to 100,000 to truly accomplish this. This has to be a nationwide coordinated effort.”
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