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  P3.06 - Poster Session 3 - Prognostic and Predictive Biomarkers (ID 178)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Biology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12468

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    P3.06-028 - Approach to Biomarker Testing: Perspectives from Various Specialties (ID 2426)

    09:30 - 09:30  |  Author(s): N. Leighl
    • Abstract

    Background
    Currently, biomarker testing for lung cancer is not uniformly integrated into the Canadian public healthcare system, despite its clear importance for patient outcomes. In order to better understand the current practice pattern for lung cancer biomarker testing, we assessed physician perspectives by specialty and region.

    Methods
    A national survey of Canadian specialists was conducted to understand their perspective on biomarker testing in lung cancer. An 11-item survey was developed to assess current practice and challenges related to biomarker testing. The survey was sent to 375 specialists (150 medical oncologists, 75 pathologists, 150 respirologists/thoracic surgeons) with a focus or interest in the management of lung cancer.

    Results
    The overall response rate for the survey was 36%, (38% of medical oncologists, 24% of pathologists, and 40% respirologists). It is understood that knowing tumour genotyping results at the time of the initial medical oncology consultation impacts patient outcome and influences the treatment decision (98%). To date, medical oncologists most commonly initiate molecular testing (67%), however, most respondents suggested a shared model for initiating the testing involving medical oncologists and pathologists is needed. The current perception is that less than two-thirds of patients have testing results available at the time of initial medical oncology consultation. Barriers identified to routine testing for all advanced lung cancer patients include cost, lack of funding for molecular testing, tissue availability and the quality of the tumour sample.

    Conclusion
    There was clear agreement that biomarker testing is important in determining the most appropriate initial treatment for patients with advanced NSCLC. There is a need for national consensus on who should initiate molecular testing. Moving forward, clear clinical guidance for pathologists needs to be established for molecular testing as part of the lung cancer diagnostic process. This includes defining the population to be tested, timing, and the tests to be performed. This may be facilitated by including more information on diagnostic sample requisitions, such as clinical suspicion of lung cancer primary (versus metastasis from another site), other cancer history, and other samples collected (and tested) previously or planned (e.g. planned resection). Pathologists need to incorporate routine EGFR, ALK testing into diagnostic lung cancer algorithm. This and greater clinical information on sample requisitions will minimize unnecessary tissue sections and allow the most efficient use of available tumour tissue for molecular testing. Incremental laboratory funding is required throughout the Canadian public healthcare system in order to provide the current standard of molecular testing required for NSCLC. Turnaround times need to be clearly established and monitored. Implementation of the College of American Pathologists (CAP) guidelines for transport from diagnostic lab to molecular testing lab (3 days), and turnaround for test results (10 days) will also improve the proportion of patients with test results available at initial consultation. Finally, feedback to clinicians, including sample quality, volume, whether or not testing was successful, and molecular results is necessary in a timely manner.