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IASLC LUNG CANCER NEWS / JUNE 2020
Mesothelioma Patient Research from page 9
team of mesothelioma clinical nurse specialists (CNSs). Mesothelioma UK is committed to ensuring that those diagnosed with mesothelioma have support opportunities equal to that of all patients with cancer through National Health Service (NHS) access to a nurse specialist who is an expert in all aspects of mesothelioma. Currently, the charity provides funding for 25 mesothelioma CNSs based in NHS hospitals across the United Kingdom. Creating a national expert team of specialist nurses has enabled nationwide insight and experience to be generated and collated regarding mesothelioma. Linking with academic colleagues and institutions, the following studies have been developed with and fully supported by the Mesothelioma UK CNS team. Mesothelioma and Radical Surgery (MARS STUDY 2): Patient Experience Arm of a Feasibility Trial 1 MARS 25,6 aimed to evaluate the benefits of surgery by comparing chemotherapy and surgery against
Broad Molecular Testing from page 8
genomic alterations that open the door to clinical trials of investigational therapies. “NGS should absolutely be the standard of care at this point, especially now that payers are starting to cover it,” said Nathan A. Pennell, MD, PhD, of the Taussig Cancer Institute, Cleveland Clinic Foundation. Three tissue-based NGS tests have been approved by the U.S. Food and Drug Administration for patients with lung cancer: FoundationOne CDx, the Oncomine Dx Target Test, and the MSKIMPACT assay. Moreover, in 2017, the U.S. Centers for Medicare and Medicaid Services (CMS) approved coverage of NGS testing under the Parallel Review Program, and private payers have started to follow suit. “There are too many biomarkers to do individual gene tests anymore; you just can’t get them all done. And it costs a lot more to do multiple tests and bill for each individually than it does to do one NGS test,” Dr. Pennell said. Dr. Pennell and his colleagues recently devised a mathematical model that showed that upfront tissue-based NGS testing was both faster—with a 2-week turnaround time—and less costly than testing sequentially for alterations in EGFR, ALK, ROS1, BRAF, MET, HER2, RET,
chemotherapy alone. Semi-structured telephone interviews were conducted post-randomization, post-surgery (surgery arm), and at 6 and 12 months.
ing the incidence of mesothelioma confirmation review among UK military personnel and a literature review explorand veterans, although it is suspected that this group may ing the existing encounter particular chalresearch about Receiving a Diagnosis of lenges, including securing the psychologMesothelioma (RADIO timely diagnosis, accessing ical effects of STUDY Meso): Improving the care and support, and obtainmesothelioma 2 Patient Experience ing financial help. MiMES aims on patients and Dr. Clare Gardiner RADIO Meso5,7 aimed to address these issues. caregivers. to understand the experiData collection is Once ethics clearance has been obtained, ence of communicating a now complete, analysis is diagnosis of malignant ongoing, and findings approximately 10 participants are pleural mesothelioma are being tested among expected to be interviewed, beginning (MPM) from the perstakeholders. We are in the spring of 2020. Expected date of spective of patients, developing some edu- completion is summer 2022. family caregivers, and cational materials for Mesothelioma Patients’ health professionals. health professionals and other support staff Experiences of Follow-Up Key findings include the importance of providthat will help inform the Across Three NHS Trusts STUDY Ms. Liz Darlison ing the diagnosis as an ongoprovision of services to A qualitative study using 5 ing process and the need to individuals with an armed documentary analysis, provide continuity and consistency. forces background who have been diag- interviews, and consultation meetings nosed with mesothelioma. The expected with stakeholders. The recommendations Military Mesothelioma date of completion is June 2020. developed suggest that all patients with Experience Study mesothelioma have access to a specialist MiMES PhD Studentship mesothelioma team within a streamlined STUDY (MiMES): Understanding the Impact of As part of the MiMES mesothelioma care pathway and that 3 Mesothelioma for STUDY project, Mesothelioma UK patients are equipped with the necesMilitary Personnel and Veterans has funded a PhD student, sary information to guide their decision 4 There is currently no evidence reportwho has completed her continued on page 13
and NTRK1 using single-gene tests or testing simultaneously for alterations in EGFR, ALK, ROS1, and BRAF using hotspot panels followed by single-gene tests for the remaining biomarkers.7 Although NGS offers an obvious solution for hospitals that lack testing capabilities, NGS uptake in community settings remains anemic due to many of the same clinical and logistical problems that plague single-gene tests. Obtaining adequate tissue still tops the list of challenges. “Frequently in the community, tissue is obtained by bronchoscopy, so bronchoalveolar lavage or fine needle aspira-
one must take negative liquid biopsy results with a grain of salt due to variable amounts of tumor DNA shed into circulation and lower sensitivity levels compared with tissue-based testing, positive results are clinically actionable. Thus, plasma NGS offers a means to enhance testing rates and improve widespread delivery of molecularly guided therapy. Aside from leveraging tissue or plasma NGS for newly diagnosed patients with lung cancer, Dr. Pennell believes that one of the simplest ways to improve broad molecular testing within institutions is to promote internal communication.
Although NGS offers an obvious solution for hospitals that lack testing capabilities, NGS uptake in community settings remains anemic due to many of the same clinical and logistical problems that plague single-gene tests. Obtaining adequate tissue still tops the list of challenges. tion cytology is all that is available,” Dr. Gutierrez said. “The lack of tissue when you want to do tissue-based NGS can be a nightmare,” which has prompted Dr. Gutierrez to order plasma-based cell-free circulating tumor DNA NGS testing up front in appropriate settings—for example, if a patient is referred to him with only a fine needle aspiration specimen. Accumulating data support the use of plasma NGS as a worthy tool for genomic biomarker testing, especially in situations where tissue is scarce.8,9 Although
“Have a conversation with all the stakeholders—the pathologists, the interventional radiologists, the pulmonologists, the surgeons—to make sure everyone knows the importance of molecular testing and ensures that it’s a priority.” Dr. Pennell hopes that these conversations will boost lung cancer to the same level as breast cancer in terms of molecular testing. “You’d be shocked if you walked into any oncology office in America to see a woman with breast cancer who did not have a pathology
report listing estrogen-receptor, progesterone-receptor, and HER2 FISH status along with the diagnosis and grade,” he explained. “Molecular testing has become a standard component of breast cancer care. And yet when we talk about lung cancer, molecular testing doesn’t get that same gut-level understanding of how important it is. It almost seems more optional, and it’s not,” Dr. Pennell said. ✦ Please note that the full reference list for this article appears online at lungcancernews.org. References: 1. Jordan EJ, Kim HR, Arcila ME, et al. Prospective comprehensive molecular characterization of lung adenocarcinomas for efficient patient matching to approved and emerging therapies. Cancer Discov. 2017;7(6):596-609. 2. Nadler E, Espirito JL, Pavilack M, Boyd M, Vergara-Silva A, Fernandes A. Treatment Patterns and Clinical Outcomes Among Metastatic NonSmall-Cell Lung Cancer Patients Treated in the Community Practice Setting. Clin Lung Cancer. 2018;19(4):360-370. 3. Gutierrez ME, Choi K, Lanman RG, et al. Genomic profiling of advanced non-small cell lung cancer in community settings: gaps and opportunities. Clin Lung Cancer. 2017;18(6):651659. 4. Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. J Thorac Oncol. 2018;13(3):323-358.
