Dr. Carbone on the Importance of Biomarker Testing for Patients With Lung Cancer

David P. Carbone, MD, PhD, director of the James Thoracic Oncology Center at The Ohio State University Comprehensive Cancer Center, discusses the importance of biomarker testing for patients with lung cancer.

“Today, virtually every aspect of lung cancer care is determined by the effective use of biomarker testing,” Dr. Carbone said. “Initially, that testing was most impactful in metastatic disease. But now, more and more, we are evolving our treatment strategies for earlier-stage disease in a biomarker-dependent way, and it is incumbent on anyone who treats lung cancer to put a priority on the assessment of relevant biomarkers before making any therapy decisions.”

Despite the growing role of biomarker testing in lung cancer, it’s important to recognize that the rate of biomarker testing is currently “not 100%,” Dr. Carbone explained.

“Overall, it’s about 70% or 80% of patients who get some kind of biomarker testing, which is insufficient by itself,” he said.

According to Dr. Carbone, recent data show that less than half of patients are receiving biomarker testing results before starting treatment.

“We’re often in a situation where a patient has started on an empirically chosen therapy and then a biomarker result comes back and we suddenly have to change that approach. That’s not an ideal situation,” Dr. Carbone said.

This makes it critical to wait to initiate therapy until the biomarker testing results come back.

“Lung cancer is the poster child for molecularly informed therapies, and there are subsets of lung cancer where they may be small—3% to 5% or a few percent—but the therapy is completely different with knowledge of the biomarker than it would be if the biomarker were absent,” he said.

The biomarker information can help clinicians ensure that patients are receiving the most appropriate therapy for their specific type of lung cancer.

“It’s incumbent upon practitioners to do a thorough biomarker analysis for the good of their patients, because the difference could be treatment with an ineffective immunotherapy in a patient with an EGFR or ALK mutation when there’s an available, simple, nontoxic oral agent that has a durable clinical benefit and is just one pill a day perhaps,” Dr. Carbone explained.

Beyond ensuring that the biomarker testing is done, it’s critical to make sure that the information from the test is put into practice, he said.

“Sometimes the biomarker testing is not acted on. Even if it is sent, the appropriate action is not done,” Dr. Carbone said. “There’s a lot of room for improvement in the implementation of biomarkers in practice today.”

As the treatment landscape evolves and more targeted therapies are approved in earlier lines of treatment for patients with lung cancer, it’s important to ensure that all patients receive biomarker testing.

“I think comprehensive biomarker testing is important for every patient and, as I mentioned, in every stage of disease as well,” Dr. Carbone said. “Not just metastatic patients, but even patients undergoing surgery or chemo and radiation for stage I, II, or III [disease] should definitely have biomarker testing.”

He concluded by explaining how clinicians can talk to patients about waiting to start therapy until their biomarker testing results are available.

“I know it’s difficult for newly diagnosed patients to wait for molecular testing results, but if it’s explained to them how important it is to pick the right therapy rather than the convenient therapy, I think virtually every patient can wait,” Dr. Carbone said.