Interview with Prof Er on the clinical utility of comprehensive biomarker testing
Dr Er is Professor of Internal Medicine and Medical Oncology and Head of Department of Medical Oncology at Acıbadem University Medical Faculty in Istanbul. As a medical oncology specialist, she diagnoses and treats solid tumors in adults using chemotherapy, immunotherapy, hormone therapy and targeted therapy. She is delighted that precision medicine has progressed rapidly during her medical practice. During this interview, she will tell you more about this approach to patient care that allows her to select treatments that are most likely to help her patients based on a genetic understanding of their disease.
OncoDNA: Good morning, Prof Er. As a medical oncologist, could you please explain how genomics supports your daily work?
Prof Er: In my daily routine I see many patients with different types of diagnosis. Lung cancer, more particularly, is very common among men and women. As medical oncologists, you need to perform molecular tests on tumor biopsies to guide your treatment decisions. Running these tests is expensive and time consuming.
OncoDNA: Have you found a solution to cope with these disadvantages?
Prof Er: In some newly diagnosed metastatic nonsmall cell lung cancers, the amount of tissue is limited because the biopsy material is very small. If you want to perform a test it is fine, but when you need to run more than one test, it becomes a problem. For most cancers, every day there is a new biomarker or a new actionable mutation that you should test. Starting with PDL-1 we need to test EGFR, ALK, ROS, BRAF NOW ALSO KRAS, MET, RET, HER2 are included in actionable mutations in nonsmall cell lung cancer. MSI, NTRK, FGFR and many others for most of the malignancies are also required. So the solution here is to run all the tests together, meaning combining NGS with IHC to analyze protein expression and RNA expression.
OncoDNA: What is the added value of running DNA, RNA and protein biomarker tests in parallel?
Prof Er: It is very important to use the comprehensive genomic profiling for most cancers and many other tumor types such as sarcomas to save time and money. This wide panel solution also helps to determine the best optimal treatment options for a patient. Additionally, multigene sequencing acts as a tool to screen patients eligible for clinical trials and to accelerate drug development, and prospectively capture the data that could further inform how to optimise the use of this technology.
OncoDNA: Have you noticed any difference in the way your patients’ outcome since the integration of comprehensive biomarker testing in your clinical practice?
Prof Er: Let me give you one example, the example of a young female patient diagnosed with metastatic nonsmall cell lung cancer. At first, we had tested for PDL1, EGFR, ALK and ROS. All the biomarkers were negative, so we started chemotherapy. During treatment, I recommended to my patient to undergo a comprehensive genomic profiling. It resulted that the patient was living with a HER2-mutant cancer. It gave her another treatment option than chemotherapy. We started the treatment and the patient responded very well. Thanks to comprehensive testing, the patient obtained a different treatment option which led to a longer survival.