A multicenter study in Germany reports that it is feasible to routinely conduct high-quality molecular analysis of non-small cell lung cancers (NSCLC) in local community hospitals that are not affiliated with academic medical centers.
The study suggests that molecular testing can be made available to more patients, and in many cases, through hospitals closer to patients' homes.
"Several of the most effective drugs used to treat advanced non-small cell lung cancer today are only effective in patients whose tumours have specific molecular biomarkers," explained lead author Thomas Zander, MD, of the University Hospital in Cologne.
"Because of advances in molecular testing technologies for these biomarkers and the ease of doing this testing today in many laboratories, our research shows that state-of-the-art personalised medicine is possible in community hospitals, and not just in advanced academic medical centers."
Targeted therapies used to treat NSCLC include erlotinib, which targets a molecule called EGFR1 (epidermal growth factor-1) and crizotinib, which targets cancers with a translocation in a gene called ALK. Other genetic features known to influence NSCLC outcomes include KRAS, BRAF, PIK3CA, ERBB2 and FGFR1; investigational drugs targeting these features are being evaluated in clinical trials.
Until recently, testing for these genetic features was primarily available in academic medical centers, and was often not easily accessible for patients treated in community hospitals.
In this study, researchers established a molecular screening network (the Network Genomic Medicine Lung Cancer) that included a variety of non-academic community hospitals in the Cologne-Bonn area of Germany. Seventy-seven percent of 1,782 lung tumour samples obtained during tumour biopsy at community hospitals were suitable for analysis and were sent to a central laboratory to be tested for the molecular features mentioned above.
Among patients with lung adenocarcinomas (the most common type of NSCLC), KRAS mutations were found in 32 percent of samples, EGFR mutations in 13 percent, ALK alterations in 3 percent, BRAF in 2 percent, PIK3CA in 2 percent and ERBB2 in 2 percent. Among patients with squamous cell cancers, 15 percent of tumours had FGFR1 amplification.
Overall, 40 percent of NSCLC samples harbored genetic mutations that could be targeted with available therapies. All patients with ALK mutations who were eligible for crizotinib received the drug, and three-quarters of patients with alterations in EGFR received drugs targeting this protein, such as erlotinib.
Dr. Zander noted that the cost of testing is not exorbitant, and is roughly comparable to about one to two weeks of therapy in the U.S. He added that testing can identify which patients are most likely to benefit from certain drugs and which may be spared from the cost and side effects of drugs that are unlikely to be effective.