Multiple treatment options are available for patients with advanced non-small cell lung cancer (NSCLC).
According to NCCN Guidelines, second- and third-line treatment options for NSCLC include:1
- Docetaxel
- Pemetrexed
- Erlotinib
- Platinum-based combinations, if erlotinib was given in the first-line
Based on randomized Phase III trials, current therapies demonstrated a median overall survival of approximately six to eight months in second- and third-line NSCLC patients.
Identifying appropriate therapy for patients is key to improving patient outcomes.
Therapeutic decisions are commonly based on patient characteristics such as:2
- Performance status
- Histology
- Ethnicity
- Smoking history
However, recent developments in biomarkers are identifying patient groups that perform better on targeted therapies.9
Obtaining tissue for biomarker testing in the second- and third-line setting poses significant challenges:
- Biopsy sample collection from patients is invasive.4
- Patients with comorbidities and poor performance status may not be able to provide tissue samples.4
- NSCLC tumors are heterogeneous and EGFR expression can be different between the primary tumor and metastases.5,6
- Analysis of tissue biopsy samples can take several weeks.
To address these challenges, Biodesix developed VeriStrat, a non-invasive blood test that predicts clinical benefit in patients with NSCLC treated with erlotinib.7
1 NCCN Clinical Practice Guidelines in Oncology™: Non-Small Cell Lung Cancer, v.1.2010. http://www.nccn.org/
2 Bonomi PD, Buckingham L, Coon J. Selecting patients for treatment with epidermal growth factor tyrosine kinase inhibitors. Clin Cancer Res. 2007;13:s4606-s4612.
3 Shepherd FA, Rodrigues Pereira J, Ciuleanu T, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005;353:123-132.
4 Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology. 1999;212:165-168.
5 Eberhard DA, Giaccone G, Johnson BE. Biomarkers of response to epidermal growth factor receptor inhibitors in Non-Small-Cell Lung Cancer Working Group: standardization for use in the clinical trial setting. J Clin Oncol. 2008;26:983-994.
6 Moroni M, Veronese S, Sartore-Bianchi A, Artale S, Siena S. Controversial evaluation of EGFR protein and gene status in predicting response to anti-EGFR monoclonal antibodies in metastatic colorectal cancer: a case report and review of the literature. Targeted Oncology. 2008;3:127-130.
7 Carbone D, 2nd European Lung Cancer Conference, April 2010.
8 Soria JC, Application and limitation of biomarker analysis: session discussion. Presented at: 44th ASCO Annual Meeting; May 30-June 3, 2008; Chicago, IL.
9 Zhu CQ, da Cunha Santos G, Ding K, et al. Role of KRAS and EGFR as biomarkers of response to erlotinib in National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol. 2008;26:4268-4275.
