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Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University

Chief of Hematology/Oncology
Medical Director of Memorial Cancer Institute

Lung Cancer Video Library - Spanish Language: Video #23 Molecular Marker Testing for Advanced NSCLC
Thu, 01/26/2017 - 14:06
Author
Luis Raez, MD FACP FCCP, Faculty, Board Member
 

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.

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