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Thoracic Malignancies • Medical Oncology • NCI-CCC Tumor Board Question • Ohio State University
How would you treat metastatic NSCLC in a non-smoker with bone biopsy showing adenocarcinoma of lung origin but inadequate tissue for mutational panel or PD-L1?
Lung primary is inaccessible for biopsy and metastatic sites are only 2 small bone lesions. In a non-smoker, a driver mutation is suspected but would you forego that forgo and consider chemotherapy +/- immunotherapy?
Answer from: Medical Oncologist at Academic Institution
Molecular studies and PDL1 have become standard for patients with advanced/metastatic lung adenocarcinoma. We feel particularly strongly about doing this (molecular studies) in the never smoker, however all adenocarcinomas (and selected squamous cancers) should have this done. Cytology specimens (...
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Answer from: Medical Oncologist at Community Practice
However, unfortunately, the only FDA approved plasma test is the Roche test for EGFR mutations. This has a reasonable sensitivity for EGFR mutations by about 85% in patients who were untreated but were able to have the tissue biopsy. In a patient with insufficient tissue, the yie...