Personalizing the Treatment of Lung Cancer

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Anne S. Tsao, MD, Mark A. Socinski, MD, Corey J. Langer, MD, Alan B. Sandler, MD, and David Gandara, MD, discuss molecular testing and the treatment decision-making process.

Tsao begins the conversation by mentioning that histologically subtyping is still important because of the available treatments. In addition, it's crucial for pathologists to get adequate tissue samples and make the distinction between adenocarcinoma, squamous cell carcinoma, and neuroendocrine cancer.

Socinski notes that clinical behavior and therapeutic direction varies greatly between squamous and non-squamous patients. Bevacizumab and pemetrexed are options for non-squamous patients but are not for those with squamous histology. Socinski agrees with Tsao though oncologists will need to rely on pathologists to make the squamous/non-squamous distinction.

The need for testing has largely been governed by the evolution of therapies. Previously, Langer says, oncologists and pathologists adhered to a one-size-fits-all strategy.

Sandler says that he, and the rest of the oncology community, is curious as to how much a patient can get out of one targeted agent. As effective as a targeted agent is, it does have limitations.

Socinski adds that his practice has been studying and analyzing several targeted agents that show activity but a lot remains unknown.

Langer stresses the idea to manage patient expectations. Patients often read about new agents and expect to be cured, but Langer says it's important to file data and make decisions along the way.

Gandara explains the process to his patients by using the bus analogy: An oncologist has to look for the bus driver among 30 passengers when conducting molecular testing.