Biomarker Testing in Non-Small Cell Lung Cancer

Expert panelists are introduced and review common biomarkers in non-small cell lung cancer (NSCLC), followed by a focused discussion on EGFR mutations.

Jason Porter, MD, and fellow panelists discuss how expression of NSCLC biomarkers and biomarker testing rates may vary by patients’ clinical characteristics, including tumor histology, stage, race, and sex.

Panelists discuss available biomarker testing methodologies for metastatic NSCLC (mNSCLC), sharing how they optimize molecular profiling in their practices and whether they typically use commercial or in-house tests.

The panel discusses challenges that clinicians may experience when ordering biomarker testing for patients with mNSCLC, including insurance coverage barriers, timing of testing, insufficient biopsy samples, and inconclusive test results.

Eric Vail, MD introduces a patient case, a 71-year-old Asian woman newly diagnosed with mNSCLC, followed by a focused discussion on how the panel would have approached biomarker testing and treatment initiation for the patient.

Dr Vail shares insight into his ideal institutional approach to biomarker testing for NSCLC, emphasizing the need for local molecular pathology expertise and available in-house biomarker panels.

Panelists continue their dialogue on common challenges and barriers to use of biomarker testing in NSCLC, and share potential strategies to optimize use of testing.

Dr Jason Porter introduces three recent retrospective observational studies on use of biomarker testing in mNSCLC, which identified racial and socioeconomic disparities in testing patterns.

Expert panelists react to the presented data on racial and socioeconomic disparities in biomarker testing for patients with mNSCLC, and align on ways to address and overcome these disparities.

Dr Ana Velázquez Mañana introduces a second patient case, a 59-year-old Black man diagnosed with mNSCLC and an EGFR exon 20 insertion, and outlines first-line treatment selection for the patient.

Continuing the discussion of the presented case of EGFR exon 20-mutant mNSCLC, Dr Velázquez Mañana outlines how the patient experienced disease progression on first-line treatment, after which the panel shares clinical insights and best practices on how they might approach subsequent treatment selection in this scenario.

A brief overview of study design, patient demographics, data from the phase 1 CHRYSALIS trial, which assessed the safety and efficacy of amivantamab in patients with EGFR exon 20-mutated, advanced or metastatic NSCLC.

Dr Jason Porter presents safety and efficacy data from a Phase 1/2 study on mobocertinib in patients with mNSCLC.

Dr Porter presents recent conference data on a matching-adjusted indirect comparison of amivantamab and mobocertinib for treatment of EGFR exon 20-mutated mNSCLC, and panelists weigh in on factors influencing selection between the two regimens.

Dr Velázquez Mañana revisits the second patient case and details the use of second-line amivantamab for the patient’s disease progression, and the panel confers about adverse event management strategies for patients taking this regimen.

Experts consider how they might approach third-line treatment selection for patients with EGFR exon 20-mutated mNSCLC who experience disease progression on amivantamab or other second-line therapies.

Closing thoughts from a panel of NSCLC experts, with an emphasis on improving access to and utilization of biomarker testing for patients with the disease.