GRACE :: Lung Cancer


genomic testing

Denise Brock

Lung Cancer Video Library 2017 – Liquid Biopsies for Broad Genomic Testing in Lung Cancer



GRACE Cancer Video Library - Lung



We are pleased to have Nathan Pennell, MD, PhD, Director of Lung Cancer Medical Oncology at the Cleveland Clinic Taussig Cancer Center in Cleveland Ohio share with us 2017 updates for our  Lung Cancer Video Library.  

In this latest video, Dr. Pennell discusses liquid biopsies for broad genomic testing in lung cancer.





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Can Patients Benefit from Broad vs. Focal Genetic Testing?




Drs. Ben Solomon, Leora Horn, & Jack West evaluate the merits of broad genetic testing with a “next generation sequencing” platform compared to selective, limited testing for the most proven driver mutations in patients with advanced NSCLC.

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Dr. West:  One of the bigger questions in the whole management of lung cancer is now whether and how often to do broad genomic testing, or really focal testing for a few clearly actionable mutations like EGFR, ALK rearrangement, ROS1, perhaps others that may emerge. What’s your approach — where do you think that your rank and file community oncologist should be, in terms of using broad genomic testing to find, not only the more common ones, but the rarer ones? Do we have enough rare mutations now to widen the scope of our looking, or are there barriers, whether it’s the turnaround time, or others interpreting the results of various rare rabbit holes to go down, that it make it not ready for prime time? Leora, what do you think?

Dr. Horn:  A lot of academic sites are doing it because we have clinical trials. If we’re talking about practical, you know, what day-to-day, I think that it’s important, at minimum, to do EGFR, ALK, ROS, RET, and even BRAF, because there’s been some promising data. If you can get that all done, and maybe it’s through multiplex testing, or next generation sequencing — the problem is, sometimes these test results come back and you get mutations, you don’t know what to do with them, or there’s nothing available for those patients. So, for a day-to-day, practical, we should do those minimal, actionable mutations. I think it’s always nice to know the additional information, but I don’t think it’s essential in making treatment decisions.

Dr. West:  Ben, what do you think?

Dr. Solomon:  So, I agree — I think what’s essential is that a patient gets the best available treatment. Now, the best available treatment will vary from place to place, and country to country, but currently, in most places around the world, EGFR inhibitors and ALK inhibitors are available, and guidelines from professional societies, such as the College of Pathologists, and ASCO, and IASLC, recommend at a minimum testing for EGFR and ALK, and I think that’s a minimum. Now, I think there’s a good case for adding things like ROS1, because of availability of crizotinib, and with the availability of trials at different molecular targets, I think there is a good reason, in most academic centers at least, to expand the panel to include a larger number of actionable mutations, and I think the eventual place that we’ll get to is where all of these tests get done in one test, and we get a report analogous to a Foundation Medicine report that sums up the actionable mutation.

Dr. West:  Yeah, I think once get beyond three of four, it starts to tip the scale toward just get everything at once. I mean, if we’re moving to a time when HER2 mutations, and MET over amplification, as well as, as you said, BRAF, and others, I mean, there’s RET — the list is getting long enough, and it seems that we’re adding maybe one or two every year or so, that hopefully it will be worth doing a broad panel approach for the majority of patients. But, as you say, it depends on where you are and what your access is.

Dr West

My Top Five Highlights in Lung Cancer from 2014


An annual tradition is a reflection on the key developments in the field over the past year. This year saw some major advances, with several of the biggest changes bubbling just below the surface and about to really break out in 2015.  So without further adieu, here’s my list.

For those who wish to access the pdf, it’s here: Top 5 Highlights in Lung Cancer 2014

Agree? Disagree? What’s highest on your wish list for 2015?

Squamous Lung Cancer, Part 2: Genomic Testing by Dr. David Spigel


Chart and graph representing genetic mutations across 12 different cancer typesDr. David Spigel, Sarah Cannon Cancer Center, discusses the importance of genomic testing in squamous lung cancer.


Squamous Lung Cancer, Part 2: Genomic Testing Audio Podcast


What you’ll hear in Part 2:

  • Molecular testing (also called genetic or genomic testing) in squamous lung cancer
  • Newly information about genetic targets for squamous lung cancer


Glossary of some terms you’ll hear in Part 2:

Find more cancer definitions at the National Cancer Institute’s Dictionary of Cancer Terms

  • Adenocarcinoma – Cancer that begins in glandular (secretory) cells. Glandular cells are found in tissue that lines certain internal organs and makes and releases substances in the body, such as mucus, digestive juices, or other fluids. Most cancers of the breast, pancreas, lung, prostate, and colon are adenocarcinomas.
  • ALK – A gene that makes a protein called anaplastic lymphoma kinase (ALK), which may be involved in cell growth. Mutated (changed) forms of the ALK gene and protein have been found in non-small cell lung cancer. These changes may increase the growth of cancer cells. Checking for changes in the ALK gene in tumor tissue may help to plan cancer treatment.
  • B-RAF – A gene that makes a protein called B-RAF, which is involved in sending signals in cells and in cell growth. This gene may be mutated (changed) in many types of cancer, which causes a change in the B-RAF protein. This can increase the growth and spread of cancer cells.
  • EGFR – The protein found on the surface of some cells and to which epidermal growth factor binds, causing the cells to divide. It is found at abnormally high levels on the surface of many types of cancer cells, so these cells may divide excessively in the presence of epidermal growth factor. Also called epidermal growth factor receptor, ErbB1, and HER1.
  • Genomics – The study of the complete genetic material, including genes and their functions, of an organism.
  • Oncogenic drivers – That which causes the formation, or supports the progression, of a cancer.
  • Oral therapy – A drug taken by mouth.
  • Personalized medicine – In cancer, personalized medicine uses specific information about a person’s tumor to help diagnose, plan treatment, find out how well treatment is working, or make a prognosis.
  • ROS1 – A receptor tyrosine kinase (RTK) of the insulin receptor family. ROS1 fusions were identified as a potential “driver” mutation in non-small cell lung cancer. (My Cancer Genome)
  • Squamous lung cancer – One of the three sub-types of lung cancer.


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