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Non–Small-Cell Lung Cancer Testing Can Be Offered Routinely in Community Hospitals

August 2012 Vol 5, No 5, Special Issue ASCO 2012 Payers' Perspective - Lung Cancer
Wayne Kuznar

Chicago, IL—Searching for ways to improve outcomes and increase access to molecular testing for patients with non–small-cell lung cancer (NSCLC), investigators have shown that it is possible to perform high-grade molecular testing regularly for NSCLC in area community hospitals that are not tied to academic medical centers.

Some of the most effective drugs for the treatment of NSCLC work optimally only in patients with tumors that contain certain molecular biomarkers. Targeted therapies to treat NSCLC include erlotinib, which targets EGFR1 (epidermal growth factor receptor 1), and crizotinib, which targets cancers with a translocation in the anaplastic lymphoma kinase (ALK) gene.

“Because of advances in molecular testing technologies for these biomarkers and the ease of doing this test­ing today in many laboratories, our research shows that state-of-the-art personalized medicine is possible in community hospitals, and not just in advanced academic medical centers,” said lead investigator Thomas Zander, MD, of University Hospital in Cologne, Germany, and the Network Genomic Medicine Lung Cancer, a regional screening network in the Cologne-Bonn region of Germany.

The Network Genomic Medicine Lung Cancer was built for this study, which involved a number of community hospitals in the Cologne-Bonn region of Germany that were not affiliated with academic centers in 2010.

For the study, 77% of 1782 lung tumor samples collected from biopsies in community hospitals were shipped to a laboratory to be tested for the molecular features mentioned above.

The molecular testing revealed KRAS mutations in 32% of the samples, EGFR mutations in 13%, and ALK modifications in 3%; BRAF, ERBB2, and PIK3CA mutations were each detected in 2% of samples. Among patients with squamous-cell cancer, FGFR1 amplification was detected in 15%.
Approximately 35% of cancers in patients with NSCLC have known targetable lesions. Of the NSCLC samples that had genetic mutations, 40% could be managed with currently available targeted treatments. Crizotinib was given to eligible patients with ALK mutations. Erlotinib and similar drugs were administered to approximately three fourths of patients who had EGFR modifications.

KRAS, BRAF, PIK3CA, ERBB2, and FGFR1 are all genetic markers that are expected to influence NSCLC outcomes. Work is under way on investigational drugs to target these genetic markers as well.

Previously, genetic testing for any of these markers was usually offered only in academic medical centers, and access by patients in community hospitals was low. Of note, the cost of offering such testing in community hospital settings is not overly prohibitive, according to Dr Zander. This cost is equal to approximately 1 to 2 weeks of therapy in the United States.

“High-quality molecular diagnostics and a personalized treatment ap­proach lead to significant benefit for patients,” he said.

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Last modified: August 30, 2012
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