This Thursday, November 7th at 8 PM Eastern, 5 PM Pacific, we'll gather in the Twitterverse for another one hour #LCSM (lung cancer social media) tweet chat. This time, the topic will be on biopsies and tissue collection.  Now that we've entered a new era where more and more of our treatments are guided by molecular markers and patient selection based on subgroups, we need more biopsy material more often.  The world has changed faster than our standard practices.  In moderating the upcoming tweet chat, I'd like to focus on three related aspects of tissue collection that represent challenges (each with a few related questions).

1) Barriers to tissue collection: Do patients understand the need for biopsy material & what it entails? What are leading barriers in getting initial tissue & perhaps additional tissue for research/trials? Are patients reluctant to undergo invasive procedures or eager to do what is needed to identify the best molecular target? Are doctors holding back on recommending sufficient biopsies that obtain enough tissue? Are costs a significant barrier at this point, such as payers not covering biopsies for molecular testing after an initial biopsy identifies a diagnosis?

2) Using results that precede strong evidence: Whether it's Foundation One panels showing novel targets and potential therapies or EGFR mutation testing in patients who have undergone surgery for early stage NSCLC, we're often getting results that lead us to consider treatments for which we don't yet have evidence of benefit from clinical trials. Should molecular testing be standard of care if there isn't a proven "actionable" result with established benefit? Should results from these more speculative findings be used only to do research or to guide commercially-based treatments? Is potential for greater understanding & novel treatments enough to consider broad molecular testing standard enough to be routinely paid for?

3) Awareness & education about molecular testing: Knowing that many lung cancer patients are not yet being tested for molecular markers for which we have proven therapies, how can we best raise awareness & change practice? Should we rely on doctors to be educated by professional societies? Change payments to incentivize docs to conform to latest recommendations for molecular marker testing? Is it more important to inform the patient and caregiver community about the latest markers, with a presumption that an educated, highly motivated patient community will lead the charge? Do we still need to do more education for patients about the importance of biopsies, and if so, how do we best convey that information?

We'd love for you to join us for the live program Thursday evening, but you can also share your thoughts here before or after that time.