Markers – it is imperative to get them?

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This topic contains 2 replies, has 2 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 1 year, 7 months ago.

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April 27, 2016 at 10:56 am  #1273797    


How important is it to have markers determined for a tumor ?
When biopsy was done, not enough live tissue was gotten to do test for markers, even though dr. said he took lots of samples . Our drs. don’t seem to think it’s a problem to not ever know them, since patient is a smoker, and unlikely he’d have one of the 4 markers that there are targeted drugs for. Would you agree with this thinking ?

Also, do they test for PD-L1 marker before giving Opdivo, or do they just give it as 2nd or 3rd line regardless of PD-L1 marker? Is PD-L1 tested thru only the advanced genetic testing which tests for apprx. 100 diff. markers?

April 27, 2016 at 11:25 am  #1273798    


If you do think that markers are very important to know — would you think a mediastinoscopy would be indicated to take out the lymph nodes including the one that is lighting up to try to get tissue for testing ? Or are the markers not soo important as to do any invasive procedure ?

Sorry for all the questions today — I’m must trying to separate them so as not to bombard you all in 1 question, but they all pertain to our current confusion. THANK YOU SO MUCH IN ADVANCE

April 27, 2016 at 6:15 pm  #1273805    
JimC Forum Moderator
JimC Forum Moderator

Hi healmymom,

It’s certainly true that EGFR mutations and ALK rearrangements are much less common in smokers than in non-smokers, but they do occur. As far as immunotherapies, however, there is evidence that response among smokers may exceed that of non-smokers. And testing may performed for any particular marker.

It’s not unusual to perform a repeat biopsy to obtain tissue for additional testing, but whether that would be worthwhile to test for mutations uncommon among smokers is debatable. Testing for PD-L1 expression is not essential, although there is evidence that those with high expression do respond at a higher rate.

On the other hand, given that only one node is lighting up and progression is not clear, it may be premature to perform the mediastinoscopy.

Forum moderator

Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then:

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