LUNG CANCER Biomarkers can change
During your initial diagnosis, doctors probably tested your cancer cells to understand what type of lung cancer you have and what might be causing it. But because your biomarkers can change throughout the course of your disease, these changes might mean different treatment options might be available to you now. See below for why retesting could be helpful.
It’s important to note that some people may not have a history of biomarker tests or may not have tested for specific biomarkers in the past. However, this doesn’t rule out the possibility of new biomarkers emerging as the cancer evolves.
Retesting could be helpful if:
- Your current treatment isn’t working as well as before
- Your cancer has spread to new areas
- There are new treatment options available that target specific biomarkers
WHAT YOU MIGHT EXPECT WITH
BIOMARKER RETESTING
If you and your doctor decide to retest for biomarkers as part of your care, your doctor may use stored tissue from a prior biopsy or take a new tissue sample from your tumor. Certain cancers may even allow for retesting to be done from a blood sample. This is called a liquid biopsy.
Doctors may recommend a new biopsy over using archived tissue in several situations including:
- If new tests are available that require recent tissue samples
- If new biomarkers with new associated therapies were approved since your last diagnosis and treatment
- If there isn’t enough stored tissue available
- If the stored tissue is too old or wasn’t preserved properly
What happens during a new biopsy?
If a new biopsy is needed, your doctor will explain which type of biopsy they recommend and why.
Some common types of biopsies include:
- A needle biopsy that goes through your skin into the tumor
- A bronchoscopy: a small tube with a camera that goes down your airway
- A minimally invasive surgery if the tumor is hard to reach
Late stage is not too late to get retested for biomarkers
Your voice is important in your care. Talk to your doctor about getting new biomarker tests. These tests may help you and your doctor understand your cancer better and help make more informed decisions about your cancer care.
Use the Biomarker Conversation Guide to help plan your talk with your doctor.
Guidelines for
biomarker testing in late-stage NSCLC
The National Comprehensive Cancer Network® (NCCN®) sets the guidelines for biomarker testing in lung cancer.
The NCCN® recommends that patients with late-stage NSCLC be tested for PD-L1 and HER2 protein overexpression and the following genomic biomarkers:
The biomarkers listed are not exhaustive, since more are being discovered through research.
TESTING FOR MET ABERRATIONS IN
LATE-STAGE NSCLC
c-Met Protein Overexpression
How it is tested Using tissue from a biopsy or surgery. MET IHC is used to determine if someone has c-Met protein overexpression
Possible treatment type Antibody-drug conjugate (ADC)
MET Gene Amplification
How it is tested Using tissue from a biopsy or surgery
Possible treatment type MET amplification is an emerging biomarker with no FDA-approved therapies currently available
METex14 Skipping Mutations
How it is tested Using tissue from a biopsy or surgery
Possible treatment type Tyrosine kinase inhibitors (TKIs)
HOW COMMON ARE MET ABERRATIONS IN NSCLC?
c-Met Protein Overexpression (EGFR wt NSq)
~13%-17% of patients
MET Gene Amplification
~2%-5% of patients
METex14 Skipping Mutations
~2%-4% of patients
c-MET protein overexpression is defined as ≥50% of tumor cells with strong staining intensity (IHC 3+).
The presence of biomarkers doesn't necessarily mean that associated treatments will be more effective or safe. Some patients might have more than one biomarker.
Biomarkers and approved medications are frequently updated. Regularly check with your doctor about newly approved medications and testing recommendations.