Future perspective for the application of predictive biomarker testing in advanced stage non-small cell lung cancer

Vincent D de Jager; Wim Timens; Arnaud Bayle; Johan Botling; Luka Brcic; Reinhard Büttner; Maria Gabriela O Fernandes; Libor Havel; Maximilian Hochmair; Paul Hofman; Annelies Janssens; Léon van Kempen; Izidor Kern; José Carlos Machado; Katja Mohorčič; Sanjay Popat; Aleš Ryška; Jürgen Wolf; Ed Schuuring; Anthonie J van der Wekken

doi:10.1016/j.lanepe.2024.100839

Future perspective for the application of predictive biomarker testing in advanced stage non-small cell lung cancer

Lancet Reg Health Eur. 2024 Mar 1:38:100839. doi: 10.1016/j.lanepe.2024.100839. eCollection 2024 Mar.

Authors

Vincent D de Jager¹, Wim Timens¹, Arnaud Bayle², Johan Botling³, Luka Brcic⁴, Reinhard Büttner⁵, Maria Gabriela O Fernandes⁶, Libor Havel⁷, Maximilian Hochmair^{8

9}, Paul Hofman¹⁰, Annelies Janssens¹¹, Léon van Kempen¹², Izidor Kern¹³, José Carlos Machado^{14

15

16}, Katja Mohorčič¹⁷, Sanjay Popat¹⁸, Aleš Ryška¹⁹, Jürgen Wolf²⁰, Ed Schuuring¹, Anthonie J van der Wekken²¹

Affiliations

¹ Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
² Oncostat U1018, Inserm, Paris-Saclay University, Gustave Roussy, Villejuif, France.
³ Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy of University of Gothenburg, Gothenburg, Sweden.
⁴ Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
⁵ Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany.
⁶ Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
⁷ Charles University and Thomayer Hospital, Prague, Czech Republic.
⁸ Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria.
⁹ Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria.
¹⁰ IHU RespirERA, FHU OncoAge, Nice University Hospital, Côte d'Azur University, Nice, France.
¹¹ Department of Oncology, University Hospital Antwerp, University of Antwerp, Edegem, Belgium.
¹² Department of Pathology, University Hospital Antwerp, University of Antwerp, Edegem, Belgium.
¹³ Laboratory for Cytology and Pathology, University Clinic Golnik, Golnik, Slovenia.
¹⁴ Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.
¹⁵ Faculty of Medicine of the University of Porto, Portugal.
¹⁶ Institute for Research and Innovation in Health (i3S), Porto, Portugal.
¹⁷ University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.
¹⁸ Lung Unit, Royal Marsden NHS Trust, London, England, UK.
¹⁹ The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, Czech Republic.
²⁰ Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.
²¹ Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Abstract

For patients with advanced stage non-small cell lung cancer (NSCLC), treatment strategies have changed significantly due to the introduction of targeted therapies and immunotherapy. In the last few years, we have seen an explosive growth of newly introduced targeted therapies in oncology and this development is expected to continue in the future. Besides primary targetable aberrations, emerging diagnostic biomarkers also include relevant co-occurring mutations and resistance mechanisms involved in disease progression, that have impact on optimal treatment management. To accommodate testing of pending biomarkers, it is necessary to establish routine large-panel next-generation sequencing (NGS) for all patients with advanced stage NSCLC. For cost-effectiveness and accessibility, it is recommended to implement predictive molecular testing using large-panel NGS in a dedicated, centralized expert laboratory within a regional oncology network. The central molecular testing center should host a regional Molecular Tumor Board and function as a hub for interpretation of rare and complex testing results and clinical decision-making.

Keywords: Next-generation sequencing; Non-small cell lung cancer; Predictive biomarker testing.

Publication types

Review