Dr Rotow on the Impact of Biomarker Testing on NSCLC Treatment Outcomes

Julia Rotow, MD, clinical director, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute; assistant professor, medicine, Harvard Medical School, discusses the importance of comprehensive biomarker testing for all patients with non–small cell lung cancer (NSCLC), as well as crucial perioperative therapy considerations in this population.

Comprehensive biomarker testing is crucial for personalized treatment in NSCLC—particularly in the metastatic setting, Rotow begins. However, practical challenges include limited tissue availability, delays in obtaining tissue for testing, and long genomic profiling timelines, which especially impact patients with rapidly progressing disease requiring immediate systemic therapy, Rotow explains. These issues are becoming increasingly pertinent as perioperative therapies advance, as genomic test results also inform decisions surrounding curative-intent treatments, Rotow notes.

There is a pressing need to prioritize essential biomarker tests, such as those that detect PD-L1 expression, EGFR mutations, and ALKaberrations, before initiating therapy, Rotow emphasizes. Additionally, other tests can guide postoperative treatment decisions. Overall, improving health care processes to expedite these results is vital, according to Rotow. Emerging research aims to determine which patients will benefit from perioperative treatments, such as chemoimmunotherapy, and which patients with require adjuvant therapy. Current data indicate the benefit of immunotherapy in various perioperative settings, but optimal treatment strategies remain unclear due to a lack of randomized comparisons, Rotow explains.

Data with neoadjuvant therapy in NSCLC are compelling, she notes. Rotow says that in her practice, she prefers to use treatment regimens that include a neoadjuvant component, as this may offer disease-modifying benefits by downstaging tumors, reducing surgical complexity, and providing valuable pathologic response data. These data can guide decisions regarding the necessity of subsequent adjuvant therapy and offer prognostic information about the risk of disease recurrence. Future clinical trial designs may leverage neoadjuvant therapies to tailor treatment intensity based on patient responses in the neoadjuvant setting, Rotow concludes.