A study conducted in Virginia found that nearly a quarter of all newly diagnosed patients with advanced lung cancer were not given a test that could improve their chances for long-term survival and reduce the side effects associated with treatment.
The research team led by Ram Subramanian, a thoracic medical oncologist at the Inova Schar Cancer Institute, found that nearly one-fourth of U.S. patients whose initial biopsy revealed cancer did not receive additional biomarker testing to determine whether the patient’s cancer contained the epidermal growth factor receptor mutation — which is abbreviated as EGFR.
“The importance of testing is if they have that mutation, then the treatment is very different, and the patient outcomes are also much better,” Subramanian told WTOP’s Neal Augenstein.
A patient with an EGFR mutation can be treated with a one-pill-a-day targeted therapy, without needing chemotherapy.
“We all know that chemotherapy is not easy to undergo,” Subramanian said. “You can give only the targeted therapy, so you don’t have to come in every three weeks for IV infusion — many of them are able to function at a near-normal fashion, like continue their work, and go about their daily routine as they would want to.”
(I was diagnosed with stage 4 EGFR-positive lung cancer in November 2002, by doctors at Inova Schar. After a few months of targeted therapy and a lobectomy, I’ve been cancer-free since May 2023, while continuing my one-pill-a-day regimen)
According to the American Lung Association, EGFR-positive lung cancers represent about 10-15% of lung cancers in the U.S., most often appearing in the adenocarcinoma subtype of non-small cell lung cancer. Patients with lung cancers with EGFR mutations tend to have a minimal to no smoking history, but EGFR mutations can appear in patients with other types of lung cancer (e.g., squamous) and smoking histories.
Why it’s important to test before starting treatment
One of the challenges facing patients and oncologists is the latest biomarker testing, called next-generation sequencing, or NGS, typically can take a few weeks to complete.
“Two or three weeks is a lot of time, because a patient’s symptoms can change in that time, and just the anxiety of waiting is a lot for the patient,” Subramanian said.
In a 2024 WTOP interview, Stephen Liu, director of Thoracic Oncology and Developmental Therapeutics at Georgetown University, said the wait can be taxing on a patient.
“It’s very common for there to be this urgency to begin therapy — (which is) completely understandable,” Liu said. “You get the sense that this cancer has some momentum, and you want to start treatment yesterday.”
Subramanian said it’s important to gather all the information about a person’s particular cancer before beginning to treat it.
“If we don’t wait for that, and we start a different treatment, like immunotherapy or immunotherapy plus chemotherapy, we know that some of the patients do worse,” Subramanian said. “So it’s important that we get the testing done, and then start treatment, because not only do they do better, some of the side effects and worse outcomes that we could have with a different treatment can also be avoided.”
“The length of time the cancer is controlled, or even our chance of achieving a cure, is significantly improved when they’re on the right treatment,” added Subramanian.
He’s hopeful this study will continue to raise awareness of the importance of testing for mutations early.
“In this study we were (seeing) about 70-80% of these patients having tests done,” he said. “Some of the newer data is indicating that testing is coming as high as 90%.”
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