Biopsy Samples - 1252848

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Biopsy Samples - 1252848

My dad had a 3rd biopsy sent to a lab for next generation screening in order to identify genetic markers for targeted therapies. They received the sample in a paraffin block. We were just told that they needed it to be at least 20% malignant cells, and my dad's sample contained less than 10% malignant cells.

First time it was done with a needle aspiration and the next 2 times it was done through the esophagus, and each time we were told that the sample was not large enough. He is thinking of having a 4th biopsy. Is this dangerous? Is there a better way to find these genetic bio markers?

The 2nd biopsy did have negative results for EGFR, KRAS, and ALK. Now we wanted to test for ROS-1 and any other potential bio markers.
Dad has adenocarcinoma which responded to carboplatin, alimta and abraxane but had a severe allergic reaction to carboplatin. He also developed peripheral edema from alimta and peripheral neuropathy with abraxane, so we're anxious to find a better therapy.

Thanks in advance for any input.

Reply To: Biopsy Samples

I just need to ask also:What labs are recommended by you for ROS 1 testing?

Reply To: Biopsy Samples

Hello wnderwo, I'm very sorry to know your dad is going through this process, none of which ever seem to be easy. The only way to get genetic testing of his cancer is to have biopsy tissue and all ways of accessing are invasive, some more than others, hence some more dangerous than others. With that said there is a balance that has to be weighed between an additional invasive procedure and how helpful the info will be in getting treatment. That's why you're asking the question as so many others do.

A core needle biopsy is a standard for retrieving enough biopsy material for mutation testing. VATS is a much more invasive general operation but much less invasive than and open thoracotomy.

Below is a link to a video discussion between Dr. West a lung cancer specialist onc and Dr. Aisner a molecular pathologist at the Univ. of Colorado on molecular testing. It is a very in-depth conversation in 3 parts. I linked you to the second part where biopsy is discussed. You can listen or read the transcript. Also there are links to the other parts at the end of the post. Note there are links to other blog/posts as well.

Grace cannot make recommendations but as Dr. Aisner suggests most labs do a very good job.

One more thing. There are several other options for treatment if he can't get anther biopsy or if he doesn't have the ROS 1 mutation. Below is a blog/post on the subject,

I hope this is helpful and good luck to your dad and you,
forum moderator

Dr West
Reply To: Biopsy Samples

My own center had been sending biopsy specimens to the University of Colorado, where Dr. Aisner works, and they're among the leaders in the country in molecular marker testing in lung cancer. Recently, we've started to send to Oregon Health & Sciences University (OHSU) in Portland, which was a decision made by our pathology department.

I know that Dr. Aisner's lab can do a process called microdissection, in which they dissect out the tumor cells to get the material they test from. It's labor-intensive, but it might make it possible to use biopsy tissue from a specimen already obtained. As for whether it's worth another biopsy to test for ROS1, that's a hard calculus. The ROS1 rearrangement is only seen in about 1% of NSCLC, but it's great to find it. These discoveries have led to situations for which we don't have real answers because they haven't been well studied enough to know what to expect.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education