Exploring Why Testing in Lung Cancer is Important to Treatment Decisions

Alexander Spira, MD, PhD, a medical oncologist and director of the Virginia Cancer Specialists Research Institute and the Phase 1 Trial Program, discusses how he chooses treatment for patients with lung cancer.

Spira says the treatment decisions for patients with lung cancer have become more complicated for the non-biomarker-driven patient population, or patients without an actionable mutation. For this population, physicians have to decide on whether or not to use chemotherapy or chemoimmunotherapy first. Most look at the patient’s PD-L1 expression since higher PD-L1 scores are likely to benefit from checkpoint inhibitors alone, possibly with ipilimumab (Yervoy). Mainly this is dependent upon the individual patient, their risk, how quickly the tumor is growing, and their level of interest in doing chemotherapy. That topic is hotly debated amongst oncologists in the targeted therapy space, he explains.

Targeted therapy is the best option for patients in all those situations, according to Spira. The physician can identify which biomarkers the patient has, either by tissue-based or by blood-based assays. It has been a struggle to get patient’s testing for all the biomarkers, and that's where he thinks liquid biopsies are coming to the forefront. However, most of the targeted options are the best. Spira says the KRAS G12C drugs are likely be approved because the studies have been in second line, and once they are approved, there's going to be many studies looking at them in the first-line setting. This may be a non-chemotherapy option that directly targets the patient’s tumor type.