Expert Advice on Genetic Testing for Lung Cancer Patients | Transcript | Lung Cancer | Patient Power


Expert Advice on Genetic Testing for Lung Cancer Patients

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Dr. Spira, so you have research going on that you help lead at the community level throughout the country. So the question is who should be tested when? It sounds like there could be a zillion genes. I don’t want to say a zillion, but I know there are many more genes that you don’t know are actionable now. So what are you saying your program now as far as who to test and when?

Dr. Spira:         

We recommend testing of everybody, certainly with adenocarcinoma. Those tend to have a much higher predilection to be driven by one of these mutations. We call them driver mutations. I actually test almost all my patients, because you never know what you’re going to find. As you heard from Dr. Johnson, there are about four basic ones that we can see. There’s a smattering of other ones, which are either on guidelines, commonly known about, or you can actually find clinical trials. And these are—for example, there’s one on CMet called a skipping mutation. And even though it’s relatively rare, it has been seen, and there’s a lot of clinical activity. So I pretty much test all my patients right now with lung cancer when we can get enough tissue. Everybody does things a little differently.

Certainly, the basic ones that you see make up the majority, those should be tested in everybody. But I think a lot of us are now migrating to testing those things that we have out there that’s about five to 10 genes currently.

Andrew Schorr:           

Now, Dr. Johnson, so what do you say about testing? And I know that still—I know there have been surveys that still, throughout the country, a lot of people aren’t being tested. And I know there are issues about whether insurance will pay for it. There’s a lot of stuff. But what are you hoping can be accomplished in the cancer treatment world to help people know what they’re dealing with and whether it’s actionable?

Dr. Johnson:    

We think it’s pretty critical. And one of the things that we’ve done at both our centers and all the major centers is for a decade, we’ve been testing for multiple for at least 10 different genes. And it’s now expanded in 2013 to somewhere between two and 400. Now, one of those is a for a very practical reason, and that is that each additional test that you do, if you’re doing it sequentially, you have to retrieve the tumor tissue. Have to send it off for testing. And what you want to do is try to be as comprehensive as possible with the initial test. And one of the things that’s offered, there’s a large number of commercial providers, including one of the sponsors to this, that will do these very large hundreds of gene panels.

And one of the things that is difficult to predict is which of these is gonna be an effective target? As Dr. Spira mentioned, one of the ones, and one of my colleagues, Dr. Awad, has published a number of articles on, what Dr. Spira described as Exon 14 skip mutations of MET. And there are effective drugs for it. And I just had a patient over the past week who was tested several years ago when we didn’t know the association was a predictive marker of the benefit of the drug. And it was buried in the other material that we didn’t know, and we were able to identify it for the patient and consider that targeted therapy. So we think that you should have broad panel. You should test everybody with adenocarcinoma, because you never know which of these is gonna be informative, not only now, but into the future.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on July 19, 2017