Lung Cancer Treatment Decisions: What If Genetic Tests Don’t Reveal a Driver Mutation?

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Topics include: Treatments

How do genetic test results influence lung cancer treatment decisions? Listen as lung cancer expert Dr. Lecia Sequist, from Harvard Medical School, and patient advocate Janet Freeman-Daily discuss what patients need to know about uncovering driver mutations and targeted therapies. Dr. Sequist also explains which types of patients will benefit from immunotherapy. Watch now to find out more.

The Living Well With Lung Cancer series is a Patient Empowerment Network program produced by Patient Power. We thank Celgene Corporation, Genentech, Helsinn and Novartis for their support. These organizations have no editorial control. Patient Power is solely responsible for program content.

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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:

So what if the test doesn't identify anybody?  Should they be forlorn?  I'm going to ask Dr. Sequist, too.  If one of these genes that we rattled off doesn't show up or driver gene, should they say, oh, my God I'm out of luck? 

Janet Freeman-Daily:
No, not necessarily.  Targeted therapies are easy to take in that you can take a pill once or twice a day, but they're not the only new therapy that's come out, and most of the patients who do not have a targeted treatment can take immunotherapy.  That's the new standard of care, and it works really well.  I'll let Dr. Sequist talk to that. 

Andrew Schorr:
Let's understand that, Dr. Sequist.  So if somebody doesn't have any of those genes but both of you have mentioned immunotherapy, how does that work, and how does that help? 

Dr. Sequist:
So one quick point before we get to immune therapy is that it's really important if you are told that you don't have any specific mutations, that you make sure that the correct panel was done.  Sometimes there are small panels that may miss important genes simply because they're not part of the panel.  So the test may be negative for everything that was assayed, but it may not rule out some of these rare mutations.  Like Janet was saying, her mutation wasn't even known about at that time she had the first testing done, so she had to have repeat testing.  And this is a very common story.  So that's what I wanted to say about testing. 

But immune therapy is—really been a game changer in cancer in general including lung cancer, but this is the idea of trying to get someone's own immune system so attack the cancer.  Our bodies are supposed to do this.  Our immune system is supposed to be on surveillance for cancer cells, treat them as foreign and destroy them, but obviously if a tumor grows to a point where you're getting a diagnosis of cancer something has gone wrong in that process.  Usually it is that that tumor is camouflaging itself in some way from the immune surveillance, and some of the new treatments that have been approved over the last couple of years in multiple types of cancer essentially rip off that camouflage, allow the immune system to see that the cancer is there as a foreign invader and start to attack it. 

In lung cancer, this works best on the, as Janet was mentioning, the type of cancers that don't have a driver mutation, the types of cancers that are more often associated with a history of smoking or exposure to some other carcinogens, and immune therapy has really changed the survival and the treatment options for a large population of lung cancer patients. 

Janet Freeman-Daily:
And I just want to reiterate that it's very important that you get genomic testing before you start immunotherapy, because the data we have now indicates that immunotherapy usually does not work for those of us who have driving mutations. 

Andrew Schorr:
So…

Dr. Sequist:
…and it may increase the toxicity of some of the targeted drugs, so not only may it not work but it might harm your chances of having a nice, long response like Janet and Marisa are having. 

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 September 10, 2019