Unlocking Early Detection: How Are Diagnostic Labs Revolutionizing Lung Cancer Testing?
Indian laboratories have matched global advances step by step and play an integral role in partnering with their patient and clinical colleagues to detect, diagnose and help treat.
Lung Cancer Awareness Month 2023: Apart from prevention, we must screen, detect, diagnose and treat lung cancer early. Screen-positive patients are diagnosed on Tissue Biopsy, and molecular workup is commenced to customise treatment. The treatment depends on the tumour type and histology, the molecular biomarker positive in a particular patient, and the clinical profile and tumour stage. Hence, molecular testing is recommended in all patients with metastatic Non-Small Cell Lung Cancer (NSCLC). Within the NSCLC, those with squamous cell carcinoma histologic subtype have fewer actionable mutations than adenocarcinoma (e.g., ALK rearrangements, the common EGFR mutations) when considered individual mutations. Dr Kirti Chadha, Chief Scientific Officer, Metropolis Healthcare Limited, shares NCCN guidelines recommended at age 50 in patients with at least 20 pack-year smoking history who are at high risk:
- Radon exposure (documented, sustained and substantial)
- Occupational exposure to lung carcinogens
- Cancer history (lymphomas, cancers of the head and neck, or smoking-related cancers)
- Chronic obstructive pulmonary disease or pulmonary fibrosis
- Second-hand smoke exposure
However, the cumulative incidence of targetable molecular alterations in squamous cell carcinoma ranges from 2% to 10%; therefore, molecular testing should also be considered in these patients, mainly if a diagnosis is based on a small sampling. Therefore, molecular testing should be considered in all patients with metastatic NSCLC squamous cell carcinoma and not just those with specific characteristics, such as never smoking status and mixed histology.
Diagnostic Labs Tests
Laboratory tests assume centre stage because in non small cell lung cancer (NSCLC), tumour histology, molecular signature, and the status of PD-L1 drive treatment selection. New to the NCCN Guidelines is the addition of neoadjuvant chemotherapy plus immunotherapy as a recommended treatment approach in a subset of patients. In addition, new therapies are addressing more unique molecular targets with data for their use in the second-line setting. These new agents and their corresponding targets include fam-trastuzumab deruxtecan-nxki for HER2-mutant tumours, amivantamab and mobocertinib for tumours with EGFR exon 20 insertions, and sotorasib and adagrasib for KRAS G12C mutant tumours.
Conclusion
Hence, today, a Lung cancer patient has multiple personalized treatment options based on the clinical stage, pathologic subtype, grade, IHC, molecular biomarkers by Next Generation Sequencing and immunotherapy tests such as PD L1, MMR/MSI and TMB (Tumour Mutation Burden). Each day brings a new treatment target to light and saves another life for another day and year. Indian laboratories have matched global advances step by step and play an integral role in partnering with their patient and clinical colleagues to detect, diagnose and help treat.
