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molecular marker testing

Denise Brock

Lung Cancer Video Library – Spanish Language: Video #41 Molecular Marker Testing for Advanced NSCLC

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GRACE Cancer Video Library - Lung

 

We are pleased to continue this series of informational videos for our Spanish speaking community.  GRACE is pleased to welcome Dr. Rafael Santana-Davila, Assistant Professor with the University of Washington School of Medicine and Seattle Cancer Care Alliance.  In this 41st video for the Spanish lung cancer video library, Dr. Santana-Davila joined GRACE to discuss molecular marker testing for advanced NSCLC.


 

 

 

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Marcador Molecular para Estadio Avanzado de Cancer de Células no Pequeñas

Molecular Marker Testing for Advanced NSCLC

 

Rafael Santana-Davila, MD
Assistant Professor of Medicine
University of Washington Seattle Cancer Care Alliance
Seattle, Washington

 

Spanish TRANSCRIPT

Cuando tratamos a un paciente en estadio tres lo que esperamos es curar al paciente, desafortunadamente esto solo se lleva en el 20 al 25% de los casos y en la mayoría de los pacientes el cancer aparece de regreso. Algo que hacemos comúnmente es la terapia de consolidación, que es dar más quimioterapia después de la quimioterapia y radiación. Para escoger si se da terapia de consolidación o no es según el régimen se haya escogido. Si el régimen incluyo carboplatino y paclitaxel se le da dos ciclos más de quimioterapia después de la radiación. Cuando la quimioterapia no incluye éste último, la ventaja de dar más ciclos de quimioterapia es controversial y se debe de discutir entre el paciente y el doctor.


  

English TRANSCRIPT

When we treat a patient in stage three we hope to cure the patient, but that only happens in about 20 to 25% of them and in most cases cancer comes back. Something we commonly use is consolidation therapy in which we give more chemotherapy after the one used in the chemotherapy and radiation therapy. Choosing if consolidation therapy is the best option is based on the regimen used. If the regimen included carboplatin and paclitaxel, we will give two more chemotherapy cycles after the radiation is over. When the chemotherapy did not include paclitaxel, the benefits of giving more chemotherapy are controversial and you have to discuss it with your doctor.


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #24 What are Immune Checkpoint Inhibitors, and How Can They Treat Cancer?

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GRACE Cancer Video Library - Lung

 

We continue to provide informational videos for our Spanish speaking community and welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University.  Dr. Raez joined GRACE to discuss the basics of lung cancer.  In this 24th video for the Spanish lung cancer video library, Dr. Raez discusses immune checkpoint inhibitors, and how they can treat cancer.


 

 

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TRANSCRIPTS – Spanish and English
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¿Cuáles son los inhibidores de los puntos de control? Y ¿Cómo pueden tratar el cáncer?

Cuando hablamos de inmunoterapia es algo muy emocionante para nosotros, porque inmunoterapia es algo nuevo que después de estar usando quimioterapia por cancer pulmón por más de 30 años, finalmente tenemos.

Inmunoterapia se refiere a los inhibidores de los checkpoints o puntos de control, es importante destacar esto porque la inmunoterapia abarca muchas cosas, abarca vacunas y estos inhibidores de checkpoint no son vacunas, también habla de transferencia de células T o los CAR-T cells en enfermedades hematológicas. Por eso les quiero recordar que la inmunoterapia son muchas cosas y la que particularmente se aplica para cancer de pulmón son los inhibidores de los checkpoint.

Los inhibidores de los checkpoint son los que actúan cuando el linfocito T va a atacar al tumor, entonces el linfocito T tiene el receptor PD1 y el tumor tiene el ligando PDL1. Entonces cuando el linfocito T va atacar al tumor y este ligando y receptor se unen, hay una inhibición de la actividad del linfocito, entonces el linfocito no puede destruir al tumor.

Básicamente esta interacción entre PD1 del linfocito y el PDL1 del tumor causa que el tumor este protegido y que el linfocito no lo pueda atacar. Por eso lo que tenemos que hacer con estos inhibidores de checkpoint es bloquear el receptor del linfocito o bloquear el ligando del tumor, de manera que estos dos no se encuentren y si no se encuentran el linfocito va a ir y destruir el tumor. Por eso es tan importante esta inhibición de esta interacción.

Ahora, esto es mucho más complicado porque no solamente hay receptor PD1, hay receptores PD1, PD2, ligando PDL1 y PDL2, pero en palabras generales es una forma de como el tumor se defiende uniendo PD1 con PDL1 y hay que inhibirlo. Gracias a la tecnología, ahora tenemos muchos anticuerpos, tenemos más de 7 anticuerpos de diferentes casas farmacéuticas que inhiben el PD1 del linfocito o inhiben el PDL1 del tumor y de esa forma el linfocito puede destruir el tumor y causar una regresión del cáncer.


What are the checkpoint inhibitors? And, how can they treat cancer?

Talking about immunotherapy is exciting for us because it’s something new that we finally have, after 30 years of only using chemotherapy.

Immunotherapy includes the checkpoint inhibitors, but it’s important to discuss this because it includes other areas like vaccines or CAR-T cells therapy. It’s important to remember that immunotherapy includes different treatments, but the one that is used in lung cancer is the checkpoint inhibitors.

The checkpoint inhibitors act when the T lymphocyte is about to attack the tumor, so in that time the T lymphocyte has the PD1 receptor and the tumor has the PDL1 ligand. So, when the T lymphocyte is going to attack the tumor, the ligand and the receptor interact with each other, if there’s a lymphocyte inhibition, then it cannot destroy the tumor.

Basically this interaction between PD1 on the lymphocyte and the PDL1 on the tumor causes the tumor to be protected because the lymphocyte cannot eliminate it. That is why, we have the checkpoint inhibitors. They will block the lymphocyte receptor or the ligand in the tumor, so as a result they will not find each other, and that way the lymphocyte can kill the tumor.

Now, this is more complicated because there is not only the PD1 receptor, there are PD1, PD2, PDL1, PDL2, but in general, that is way the tumor defends itself by binding PD1 to PDL1, so we have to inhibit that step. Thanks to the technology, now we have many antibodies. We have more than 7 different antibodies from different pharmaceutical companies that inhibit the PD1 of the lymphocyte or that they inhibit the PDL1 on the tumor. That way, the lymphocyte can destroy the tumor and cause a regression on the disease. 


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #23 Molecular Marker Testing for Advanced NSCLC

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GRACE Cancer Video Library - Lung

 

We continue to provide informational videos for our Spanish speaking community and welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University.  Dr. Raez joined GRACE to discuss the basics of lung cancer.  In this 23rd video for the Spanish lung cancer video library, Dr. Raez discusses molecular marker testing for Advanced NSCLC.  


 

 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts

Pruebas de marcadores moleculares para el cáncer pulmonar avanzado

Cuando hablamos de pacientes con enfermedad avanzada, hoy en día, es una rutina obligatoria el tener que evaluar si el tumor del paciente tiene marcadores moleculares. Es muy importante, porque hoy en día tenemos diversas terapias blanco aprobadas para cancer de pulmón como: crizotinib, erlotinib, afatinib, gefitinib, ceritinib, y por esa razón, esa terapia blanco le da al paciente la oportunidad de posponer el inicio de quimioterapia para el tratamiento de cancer de pulmón y así, prolongar su vida.

Como sabemos, la quimioterapia prolonga la vida y el tiempo medio de vida de un paciente en estadio IV que actualmente es un año y medio. Entonces con las quimioterapias blanco, si se dan al comienzo, dan la oportunidad de postergar el inicio de la quimioterapia al paciente y prolongar su vida con una buena calidad.

Por eso si nosotros no nos esforzamos en tratar de encontrar estos marcadores moleculares, estamos negando al paciente la posibilidad de que se beneficie de estos agentes. Si hacemos una biopsia de aguja y no hay suficiente tejido, lo más fácil de decir al paciente cuando viene con el oncólogo médico es que no hubo suficiente tejido y que empecemos quimioterapia. Toma una iniciativa extra del médico, el decir que tenemos que repetir la biopsia y explicar y convencer al paciente porque hay un beneficio de repetir la biopsia a pesar de que es una incomodidad para él, esto con el fin de que el paciente tenga una oportunidad de ver si encontramos un marcador molecular.

Los marcadores moleculares son las mutaciones del receptor EGFR, son las translocaciones del gen ALK y translocaciones de ROS1. Hoy en día estamos buscando activamente terapias nuevas para otras mutaciones o translocaciones como para receptores RET, receptores BRAF, MET y otros genes en estudio. Hay una gran posibilidad de que el paciente se benefie de estas terapias blanco, pero es mucho por la motivación del médico y del paciente porque si no se encontraron marcadores en la biopsia de tejido se puede buscar en otros lugares como la sangre. Incluso podemos identificar marcadores en orina, como EGFR, o identificar ALK en la sangre.

No hay razón para que no insistamos que el paciente se beneficie de estos nuevos conocimientos.


Molecular markers testing for advanced lung cancer

When we talk of patients with an advanced disease, nowadays, it is a mandatory routine to evaluate if the tumor has any molecular marker. It is very important because we have many targeted therapies for molecular markers approved for lung cancer like crizotinib, erlotinib, afatinib, gefitinib and ceritinib. Targeted therapies give the patient an opportunity to postpone chemotherapy and in way, prolong their life.

As we know, chemotherapy prolongs life and the life span of a stage IV patient that is usually a year and a half. So with this targeted treatments, if used at the beginning, they give an opportunity to prolong the start of chemotherapy and have a better quality life.

That is why we strive in trying to find molecular markers, because if we don’t do it, we will be denying the patient a great opportunity to benefit from the therapy. If we make a needle biopsy and there is not enough tissue, the easiest option is to explain the patient that it wasn’t enough tissue for the testing and that we should start chemotherapy. It takes an extra initiative of the physician to say that we didn’t get enough tissue in the biopsy, but we should repeat the biopsy and with this explain to the patient the importance and benefits from this procedure. Even though the procedure is not the preferred by patients, we have to let them know that this is a great opportunity to find a molecular marker.

Molecular markers are the EGFR mutations, the ALK translocations and the ROS1 translocations. Nowadays, we are looking for new therapies and other mutations or translocations for receptors like RET, BRAF, MET and other possible genes. There is a great possibility that the patient will benefit from the targeted therapies, so the motivation from their physician is important because even if they didn’t find molecular marker in the tissue biopsy, they could find them in the blood. We can even identify markers in urine like EGFR or identify ALK in the blood.

There is no reason for us to stop insisting in the possible benefits the patient can get form this new information.


GRACE Video

What is the Role of Molecular Marker Testing in the Adjuvant or Post-Op Setting?

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Note: This is an older video and may contain outdated information.
Please view this updated video.
 
GRACE Cancer Video Library - Lung

GCVL_LU_D21_Molecular_Marker_Testing_Role_Adjuvant_Post-Op_Setting

 

Dr. Edward S. Kim from the Levine Cancer Institute in Charlotte, NC discusses the feasibility of molecular marker testing and targeted therapy in the adjuvant or post-operative setting.

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Transcript

Let’s put this in context: right now, when someone is diagnosed with lung cancer, that’s a very unfortunate situation. The majority of times, that tumor is going to be in a locally advanced, or metastatic, or spread situation where only therapy will try to slow it down. Certainly, we have great therapies now, and I’ve personally had patients who lived for years when they can take the appropriate therapy.

There are about 30% of patients out there who are diagnosed with early stage lung cancer, meaning surgery can be done, and as we get more screening with CT scans, we’re hopeful to diagnose more people earlier, rather than later.

In the setting of having a surgery done for lung cancer, the first step is to be evaluated by a surgeon, make sure you are fit to have a surgery — sometimes it’s a part of the lung, sometimes it’s more of the lung, so the rest of your lung has to be healthy enough to support the breathing requirements and the oxygen requirements your body needs. If that goes okay after a complete staging, then you undergo the surgery. In some cases, you’re done — nothing else is needed. In other cases, we have to give additional chemotherapy, or adjuvant chemotherapy, for three to four cycles after the surgery, and in some cases, not only after the surgery, but also the chemotherapy, we have to do four weeks of radiation. But, in all of those settings, we are considering the patient cured of their disease — we have delivered curative intent therapy. Again, that’s opposed to the advanced stage where we deliver chemotherapy or biologic therapy that is not meant to be curative intent, but it is meant to try and prolong the control of the disease as long as possible.

So now the question is: we have these fancy biologic drugs that are targeting certain mutations such as EGFR or ALK in the metastatic setting — can we use some of these principles in the early stage, or post-operative setting?

The answer right now, again in 2015, is no. We are not routinely testing surgical samples after surgery to see if there is a marker such as EGFR mutation or ALK translocation because we don’t know if that tissue that has that marker, and the drug — we have several drugs that target EGFR mutation and several drugs that target ALK translocation — whether they are effective in a patient who has had their tumor removed. Again, in the advanced setting where there is disease and we know we can’t cure it, we know these drugs are very effective when the marker is present to prolong the disease and help patients have better qualities of life and live longer.

In the early stage setting, the tumor has been removed, and we’re not sure that taking a pill for one year or six months has any benefit to helping prolong survival. However, there are clinical research studies that are looking at this. One of them is called ALCHEMIST, it’s being run through the NCI, and they are doing exactly this: testing for the markers, and if the marker is positive, placing that patient on the appropriate targeted therapy. The therapies are usually for about a year, sometimes two years, and we won’t get results of a study like this for years down the road, because again, when patients are diagnosed in the early stage setting, they live much longer, and we hope we don’t see their tumors come back. We want to see the effectiveness of the treatment, so it will take quite a bit of time to see the results of these studies, but at least they are underway and they are being conducted, and hopefully, in about five or six years, we will have some results.


GRACE Video

What is the Value of Testing for Molecular Markers in Advanced NSCLC?

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GCVL_LU_Testing_Value_Molecular_Markers_Advanced_NSCLC

 

Memorial Sloan-Kettering Cancer Center medical oncologist Dr. Greg Riely explains how testing for specific mutations in patients with advanced NSCLC can guide prognosis and treatment recommendations.

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Transcript

When we’re evaluating a patient with lung cancer, the first question we start to ask is, what’s going on with this patient’s cancer? Where is the disease, so has it spread to other sites, and what does it look like under the microscope? So, what’s the tumor histology, is it an adenocarcinoma, squamous cell carcinoma. And then, importantly, molecular testing has become a critical part of our understanding of a patient with lung cancer.

Now, by doing molecular testing, we’re able to better refine the prognostic and predictive value of a variety of drugs and treatments that we have going forward, for designing an overall treatment plan for a patient. Some of the most common testing that should be done are EGFR and ALK — now, these are important because these both have FDA approved drugs that are indicated for abnormalities in EGFR and ALK. If you go beyond those two things, there are actually a long list of drugs that can target individual molecular aberrations and molecular abnormalities, but they’re uncommon, and we don’t have FDA approved drugs for those things, but I think if we go beyond those EGFR and ALK tests, we can learn a lot more and sometimes help patients a great deal.


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