Episode 389: Biomarker Testing for Non-Small Cell Lung Cancer

“It’s critical to identify those mutations found that are driving the cancer’s growth and guide the personalized treatment based on those results. And important to remember, too, early testing is crucial for patients with non-small cell lung cancer (NSCLC). In studies, it has been found to be associated with improved survival outcomes and reduced mortality,” ONS member Vicki Doctor, MS, BSN, BSW, RN, OCN^®, precision medicine director at the City of Hope Atlanta, GA, Chicago, IL, and Phoenix, AZ, locations, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS^®, manager of oncology nursing practice at ONS, during a conversation about the oncology nurse’s role in NSCLC biomarker testing.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

This podcast is sponsored by Lilly Oncology and is not eligible for NCPD contact hours. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.

Episode Notes 

• This episode is not eligible for NCPD.
• ONS Podcast™ episodes:
  • Episode 363: Lung Cancer Treatment Considerations for Nurses
  • Episode 359: Lung Cancer Screening, Early Detection, and Disparities
  • Episode 238: Cancer Genomics for Every Oncology Nurse
  • Episode 157: Biomarker Testing Improves Outcomes for Patients With Non-Small Cell Lung Cancer
• ONS Voice articles:
  • Non-Small Cell Lung Cancer Prevention, Screening, Diagnosis, Treatment, Side Effects, and Survivorship
  • Only a Third of Patients With Advanced Cancer Get Biomarker Testing, Limiting Use of Potentially Effective Precision Therapies
  • Precision Medicine in Lung Cancer: How Comprehensive Testing Optimizes Patient Outcomes
  • Targeted Therapies Are Transforming the Treatment of Non-Small Cell Lung Cancer
• ONS book: Guide to Cancer Immunotherapy (second edition)
• ONS course: Genomic Foundations for Precision Oncology
• Clinical Journal of Oncology Nursing article: Using Nurse Navigators to Improve Timeliness of Biomarker Testing for Non-Small Cell Lung Cancer
• Oncology Nursing Forum article: Precision Medicine Testing and Disparities in Health Care for Individuals With Non-Small Cell Lung Cancer: A Narrative Review
• Other ONS resources:
  • Best Practices for Biomarker Testing in Non-Small Cell Lung Cancer: A Case Study
  • Genomics and Precision Oncology Learning Library
  • Genomics Case Study: Precision Medicine in the Setting of Metastatic Non-Small Cell Lung Cancer
  • Biomarker Database (refine by non-small cell lung cancer)
  • Genomic Biomarkers Huddle Card
  • Targeted Therapy Huddle Card
• National Comprehensive Cancer Network homepage

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“These biomarkers are used to provide information about cancer’s characteristics or behavior. In oncology precision medicine specifically, molecular tests can help with diagnosing a cancer that is maybe an unknown primary. It can help with monitoring response to therapy, detect recurrence of disease before other tests can find that, predict prognosis or how aggressive the cancer may be, and guide treatment decisions for targeted therapies.” TS 3:14

“Some of the key biomarkers recommended by the National Comprehensive Cancer Network (NCCN) to be tested in patients who have NSCLC are EGFR, ALK, KRAS, BRAF, MET exon 14 skipping mutation, HER2 which is a protein expression from an ErbB protein, PD-L1 which is a protein expression that’s used to guide immunotherapy choices, and then finally there are three fusions: ROS1, RET, and NTRK. [These] are pretty rare but really important to be tested for in patients who have NSCLC.” TS 3:46

“Another important challenge for nurses related to this topic is that these results may not reveal a targeted mutation for the patient and that could be very disappointing. So, being able to provide that emotional support to a patient if they have that result … you can actually reinforce with them that if [they] go onto another treatment that the physician decides to put [them] on, the tumor can change. New pathogenic variants can develop based on the treatment that they’re getting, and another test can be done. And maybe at that time—a new biomarker that could be targeted—we’d be seeing on the new test.” TS 7:32 

“Another circumstance we didn’t talk about yet is that maybe the result came back saying that the quality was not sufficient. And sometimes that happens, but that doesn’t mean that we’re at the end of the road, necessarily. So, you could explain to the patient that that may mean that possibly, a new biopsy would be ordered by the physician. Or if a new biopsy or another tissue sample is not available, then maybe the physician would pivot to sending a blood specimen for the molecular testing. So that would definitely be a way [nurses] could support their patients.” TS 11:52

“In the case of patients with NSCLC, early testing is so important. So, advocating for that prompt biomarker testing to be done, making sure that it’s comprehensive, that it’s actually looking for all of those—I think it was 12 biomarkers—that I mentioned earlier. That this testing is done as soon as possible after diagnosis or progression. Something that I talk about all the time—personalized care, precision medicine—really matters. So, tailoring treatments for patients based on the biology of the tumor that’s driving the cancer’s growth is really crucial if you’re going to be working as an oncology nurse. Another crucial thing, because it’s changing so quickly, is to stay informed.” TS 16:23