A medical oncologist offers his initial impressions of the patient profile of a 60-year-old with early-stage NSCLC and discusses biomarker testing practices, highlighting types of testing and challenges.
Case: A 60-Year-Old Woman with Early-Stage Non–Small Cell Lung Cancer
Initial presentation and Clinical Workup
This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Sandip P. Patel, MD.
This case involves a 60-year-old woman with newly diagnosed stage IIA lung adenocarcinoma who underwent appropriate surgical and adjuvant treatment, including platinum-based chemotherapy (pemetrexed) and osimertinib per the ADAURA trial regimen. However, she developed progression after almost 2 years, with new liver and brain metastases.
Key discussion points focus on the importance of timely, guideline-concordant molecular testing to help guide treatment decisions in early-stage non–small cell lung cancer (NSCLC). At minimum, Patel advocates for PD-L1 immunohistochemistry, EGFR mutation analysis, and ALK fusion testing. In the metastatic setting, he uses next-generation sequencing to assay a wider range of targetable alterations.
He notes logistical issues with testing, including financial coverage, lower yields of cell-free DNA in early-stage disease, and turnaround times that may delay treatment. Rapid single-gene assays for EGFR mutations and PD-L1 testing can facilitate quick neoadjuvant decisions when needed. Ultimately, selecting the right test for actionable results and sequencing therapies appropriately is advocated.
Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.