November is Lung Cancer Awareness Month, when we reflect on the tremendous progress we have made fighting this disease, and examine how best to improve patient outcomes moving forward. We’ve seen a significant decline in lung cancer mortality in recent decades – thanks, in part, to aggressive anti-smoking campaigns – but lung cancer remains the deadliest cancer for both men and women. Personalized medicine has the potential to reverse this trend – but only if we ensure that all advanced lung cancer patients are tested to see if a targeted treatment will help them live longer, healthier, progression-free lives.
There has been a significant acceleration in FDA approval of personalized medicines over the last decade – already in 2020, the FDA has approved more targeted therapies than in any previous year. But too many of these targeted treatments are sitting on shelves collecting dust.
Research shows that only 20 percent of lung cancer patients are undergoing complete biomarker testing to determine if they are a candidate for personalized therapy. Put differently: up to 80 percent of these patients are unaware that they might benefit from targeted treatments.
These personalized therapies have been shown to be far more effective than traditional treatments – in some cases doubling or even tripling an advanced cancer patient’s life expectancy. And, this outcome improvement is typically associated with a higher quality of life, as personalized medicines typically do not have the severe side effects commonly associated with chemotherapy and immunotherapy.
Treating late-stage cancer with personalized medicine, however, requires that physicians first conduct comprehensive genomic profiling (CGP) of a patient. (CGP is also referred to as biomarker testing, genomic testing, or genotyping.) Two patients may be diagnosed with the “same” cancer – such as non-small cell lung cancer (NSCLC) – but the tumors likely have different mutations. And that means the two patients should receive different, personalized treatments.
One reason for this undergenotyping is that until recently it’s been difficult to collect this genomic information. Best practice was to conduct a tissue biopsy – a risky, surgical procedure, especially when a tumor is buried within hard-to-reach, often compromised organs, like the lungs. Tissue biopsies also take time, which is something most advanced-stage cancer patients don’t have. As a result, physicians often skip this testing and start a patient immediately on a course of chemotherapy or immunotherapy.
Today there is an alternative. Liquid biopsy tests have made CGP faster, (a result can be obtained in as few as 7 days), safer, and easier. A liquid biopsy is obtained through a simple blood draw, but it reveals detailed DNA material shed by tumors into the bloodstream that indicate a specific genomic mutation. Physicians at large academic centers have used these tests for several years. Now, with three FDA-approved liquid biopsy tests on the market (including Guardant360 CDx, the first comprehensive liquid biopsy approved for all solid cancers), all oncologists can confidently rely on these tests for CGP and to ensure they begin patients on targeted therapies right from the start.
Star Dolbier was one of those patients who benefited from testing and personalized medicine. Star was in her early 50s when doctors discovered she had stage IV NSCLC that had metastasized throughout her body. And like 20 percent of women who develop lung cancer, Star never smoked. Her lungs were filled with fluid, making a tissue biopsy difficult. Instead, her doctors ordered a liquid biopsy, which provided immediate insight into the genomic makeup of the tumor and started her on a course of Osimertinib. By genotyping before her first line of therapy, Star’s doctors launched her on the correct treatment on the first try. Two years later, when Star stopped responding to her treatment, her oncologist conducted another liquid biopsy and shifted her to a second line treatment, to which she is responding well.
Stories like Star’s are why we should ensure all lung cancer patients undergo testing to see if they might benefit from targeted treatments. Too often when patients don’t undergo CGP testing they receive an ineffective first line therapy. And an initial misstep can eliminate the possibility of a targeted therapy down the road. The five-year survival rate for metastatic lung cancer is estimated to be less than 10 percent; and for patients who don’t receive the correct first line of therapy, it is estimated that one in two don’t survive to receive a second line of treatment.
Lung Cancer Awareness Month is the time to celebrate the huge strides that have been made in understanding and treating this disease. But it’s also a time to call attention to the serious risk undergenotyping can have on patient outcomes. This November let’s make sure no advanced lung cancer patients are left behind and that they all receive the testing and personalized care they deserve.
Helmy Eltoukhy, PhD is the CEO of Guardant Health. Guardant Health’s Clear Your View campaign focuses on educating all doctors of NSCLC patients about the value of comprehensive genomic testing to inform first-line treatment. The campaign is supported by patient advocacy groups: Go2 Foundation for Lung Cancer; LUNGevity; and ALK Positive.