Aggarwal Shines a Light on Precision Medicine in Lung, Breast, Ovarian, and GI Cancers

Charu Aggarwal, MD, MPH

Molecular testing is an established and essential precursor to treatment for patients with non–small cell lung cancer (NSCLC) based on the volume of actionable targets, such as EGFR and KRAS G12C mutations, as well as PD-L1 status, said Charu Aggarwal, MD, MPH, who added that the field is continuing to expand with emerging data on co-occurring mutations and the potential role for repeat testing.

Moreover, molecular testing is becoming equally critical in other cancers beyond NSCLC, such as breast, ovarian, and gastrointestinal (GI) malignancies, where personalized approaches are available.

“Molecular testing is here to stay,” Aggarwal said in an interview with OncLive^® during an Institutional Perspectives in Cancer (IPC) webinar on precision medicine. “We can deliver precision medicine and personalized treatment approaches based on molecular testing, be it germline [alterations] in cases of tumors like breast and ovarian, or [somatic alterations] in diseases like lung cancer—which is clearly the poster child for the application of targeted therapy—as well as GI malignancies.”

In the interview, Aggarwal, chair of the IPC event, the Leslye M. Heisler Associate Professor for Lung Cancer Excellence, and a physician at Penn Medicine, shared key messages from the meeting, which centered on the growing role of precision medicine in oncology, including molecular targets in lung cancer, testing opportunities in breast and ovarian cancers, and personalized treatment approaches in GI malignancies.

OncLive^®: What advances in NSCLC have contributed to the improvement in 5-year survival outcomes for patients?

Aggarwal: A lot of progress has been made in lung cancer over the past decade. Survival has increased from less than 5% to greater than 25%. Most of these advances have come from the availability of targeted therapy. If we look at the timeline, [the improvement in survival] coincides with the availability of the first-generation EGFR [tyrosine kinase inhibitors]. However, we will continue to see gains based on immunotherapy and how it has changed the landscape. We are potentially seeing cures.

During the IPC meeting, Payal D. Shah, MD, of Penn Medicine, spoke about genetic testing in breast cancer and ovarian cancer. How does germline testing differ from somatic testing?

Dr Shah gave 2 excellent talks on breast and ovarian cancers. We know that there is a significant role for germline testing. She talked about how germline testing may be different from tumor-based genetic testing, which patients to screen for, how to apply the results once we have them, and the use of PARP inhibitors in both diseases.

Dr. Shah also underscored the importance of recognizing genetic and racial disparities in these diseases. How could the field start to close these gaps?

We have seen that even though the prevalence of molecular mutations may or may not be different across disease types, we do see disparities in testing. There are ongoing efforts nationally and at the local levels to improve our testing rates and reduce disparities. One of the ways we will be able to do that is by formalizing institutional guidelines.

Steven J. Cohen, MD, of Jefferson Health – Abington, discussed patient selection for molecular testing in GI malignancies. For which patient populations is molecular testing necessary?

Dr Cohen gave us an excellent overview of molecular testing across different disease subtypes within GI malignancies. GI malignancies are very heterogenous, spanning from cancers of the esophagus to the duodenum to the pancreas to the colon. There are also other cancers included under the umbrella of GI malignancies. He led us through different approvals based on PD-L1 testing for immunotherapy, but also HER2 and BRCA1/2 germline testing for patients with pancreatic cancer.