"Tumor Testing Understanding Your Unique Lung Cancer"
I was 36 years old when I was diagnosed with lung cancer, and I was told I had about, um, six months to live.
My Diagnosis
When the doctor told me that I had stage 4 lung cancer, it was quite a surprise. I did not expect that answer.
My youngest child was 3 years old when I was diagnosed. To think that she wouldn't remember who I was...
When I was first diagnosed, I was so overwhelmed. I didn't know what to think. I didn't know what my treatment options were, and I didn't even know what questions to ask the doctor.
I was fortunate that my doctor knew about tumor testing, but not every lung cancer patient is that fortunate.
What Is Tumor Testing?
Tumor testing, sometimes known as molecular or biomarker testing, is an exciting advancement in lung cancer.
When a tumor is biopsied or removed, pieces of the tumor can be sent to a lab where they can be tested for specific mutations or abnormal proteins that cause the cancer to grow.
If your cancer cells have one of these specific mutations, your doctor may recommend a targeted therapy for your tumor.
Targeted Therapy
When I was originally diagnosed, the ALK mutation hadn't been identified yet. Luckily, when the mutation was discovered, my doctor had my tissue retested, and I did have the ALK mutation.
I went on a targeted therapy, and it worked really well for me.
When my results came back, I found out that I tested positive for the EGFR mutation.
After starting my targeted therapy, um, I was no evidence of disease within 8 months. All the tumors were gone.
I'm beyond grateful that my doctors ordered tumor testing for me.
Tumor testing and targeted therapy may not be for everyone, but it all starts with a conversation with your doctor.
"How to Test for Lung Cancer Biomarkers"
It should talk about all of the different genes. It'll have a list of all the ones that were looked at, and then it'll talk about any abnormalities.
Sometimes there's specific actionable mutations where we know what to do, and sometimes there'll be mutations we don't know what it means, but it might be information that'll be useful in another year or two or three, as more things are learned, and those are called variants of unknown significance.
And sometimes they really are unknown significance. They don't mean anything, but sometimes they might be useful for some point in the future.
So one thing I wanted to mention, as we think about biomarkers, some biomarkers come back quickly. Those are those protein tests, or we call immunohistic chemistry, like pdl1.
That can come back in a day or two.
The next gen suite sequencing, that more comprehensive dna analysis, that can take two to three weeks. So you can imagine that's hard to wait for those results, but really important to have that and not act just on the pdl1 result.
The liquid biopsies often can come back in about a week.
And so, with the liquid biopsy, especially if it's a comprehensive next-gen sequencing, that can get you all of the information you need to know how to best treat the tumor even faster.
"What is a lung cancer biomarker?"
A biomarker is a way of looking at a tumor to get more information than just what it looks like under the microscope.
And the biomarkers are looking at either the genes that are in the tumor and whether they've changed, or the proteins that are expressed by the tumor, to help us better understand the tumor and sometimes tailor or make the treatments more specific.
When we talk about treating metastatic or stage 4 lung cancer, there are three main categories. There's chemotherapy, there's immune therapy, and then there's targeted therapy.
There's immune therapy, and then there's targeted therapy. And for immune therapy and targeted therapy, those work best when we've got the right biomarkers in the tumor.
So for the targeted therapies, they're all based on the fact that a tumor, in order to be a tumor, has had to change in some way to make it different than normal cells.
So those are going to be mutations, and some of these mutations, in particular EGFR, ALK, ROS, BRAF, RET, MET, and NTRK, those are all genes that can be altered in a tumor.
Where we have medications that work specifically on those genes when they're altered.
If we find one of those gene mutations, or biomarkers specific to those genes, in a tumor, then we can treat the tumor best with a targeted treatment.
With the immune therapy, there's a marker called PD-L1, and there are others in development.
Where if we see that is very high, especially in the setting where a patient doesn't have one of those gene mutations, then immune therapy can work very well by itself or in combination with chemotherapy.
"When should a lung cancer patient be retested for biomarkers?"
If a patient's newly diagnosed, you've got to do that comprehensive testing with all these biomarkers to really understand the tumor.
Depending on what's found there, repeat testing might be useful in the future.
So with some of the targeted therapies, when they stop working, sometimes they stop working because of other mutations, and we can retest and look for those, and that can help us know which treatment to go with next.
But other times that repeat testing isn't as important, and so that'll be an important question to talk to about your physician.
Now, if you've ended up started on treatment with chemotherapy, or maybe chemotherapy and immune therapy, and the testing results weren't back, and then they come back later, what do you do?
Depends on how you're doing. If the treatment seems to be working and it's tolerated, you have that new information about, say, maybe EGFR, and at some point in the future, when the treatment chemo that you're on stops working, then you can switch to those targeted therapies.
Other people sometimes switch right away, but it just really depends on how you're doing. If you're tolerating the treatment well and it's working, there's no reason to switch immediately.
But understanding what's going on with the tumor at some point is really critical.
So if the comprehensive testing, the comprehensive biomarker testing, wasn't done at first diagnosis, you'll want to get it at some point, perhaps the time that that initial therapy has stopped working.
"Lung Cancer and Biomarker Testing: Two Families’ Stories"
It was incredibly shocking for my family to learn that my mom had been diagnosed with lung cancer.
When we learned that she had lung cancer, we knew it was non-small cell, but one of the things that we had learned walking into her first oncology appointment was that her physician had already sent the tumor away for genetic testing.
And that allowed us to learn a little bit more about her cancer, and we found out that she has ALK-positive lung cancer.
In 2017, my wife was diagnosed with lung cancer.
At the time, she was only 34 years old, and we had two small children.
We found out my wife is EGFR-positive.
Knowing that has opened up several different treatment options that are specifically designed to fight the disease for her.
She's been on a number of targeted therapies, and just having that piece of information and knowing how to specifically treat her type of lung cancer has been such a powerful tool.
And I can honestly say that six and a half years later, I don't know that my mom would be with us today if we did not have that piece of information and if we didn't know exactly the type of lung cancer that she had.
When a person's first diagnosed, when your loved one is first diagnosed with lung cancer, it's often overwhelming and very scary for them.
They can often forget to ask the right questions, so please go with your loved one to the doctor's appointments.
Make sure that they ask for the biomarker testing so that all the options are placed on the table, and you can choose the best option for your loved one to help fight this disease.
