Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Ave, 780 PRB, Nashville, TN, 37232, USA.
Baylor Charles A. Sammons Cancer Center, Texas Oncology PA, Dallas, TX, USA.
Adv Ther. 2023 Dec;40(12):5567-5578. doi: 10.1007/s12325-023-02664-1. Epub 2023 Oct 1.
The identification of actionable oncogenic driver mutations in patients with non-small cell lung cancer impacts therapy selection, and appropriate therapy administration results in improvements in clinical outcomes. Although biomarker testing for actionable oncogenic driver mutations is recommended in national and international guidelines, there are still unmet needs in the real world. Through this podcast we provide, from a US perspective, an overview and discuss challenges in biomarker testing from both an academic and a community oncologist viewpoint. We describe the importance of comprehensive testing, actionable biomarkers as recommended by guidelines such as National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology, types of tests and assessment techniques for detection of actionable biomarkers, and challenges in testing. These challenges include the lack of awareness of the biomarker testing guidelines among physicians, inconsistent reimbursement, longer turnaround time resulting in delays in therapy initiation, and nihilism associated with particular patient characteristics. To tackle these challenges, we offer recommendations from the perspective of our own clinical settings.
在非小细胞肺癌患者中鉴定出可操作的致癌驱动突变会影响治疗选择,而适当的治疗管理可改善临床结局。虽然在国家和国际指南中建议进行生物标志物检测以寻找可操作的致癌驱动突变,但在现实世界中仍存在未满足的需求。通过本次播客,我们从美国的角度概述并讨论了学术和社区肿瘤学家观点下生物标志物检测的挑战。我们描述了全面检测的重要性,以及 NCCN 和欧洲肿瘤内科学会等指南推荐的可操作的生物标志物,检测可操作生物标志物的检测类型和评估技术,以及检测中的挑战。这些挑战包括医生对生物标志物检测指南的认识不足、报销不一致、较长的周转时间导致治疗开始延迟,以及与特定患者特征相关的虚无主义。为了解决这些挑战,我们从自己的临床环境角度提供了一些建议。