Episode 025: Lung Cancer Series, Pt. 3: Specialized diagnostic workup in NSCLC

Lung cancer specialized testing in NSCLC: What do we do if we biopsy a suspected metastatic lesion? * Immunohistochemistry (IHC): **Confirm if it is metastatic NSCLC **Confirms the histology of the NSCLC (such as adenocarcinoma vs. squamous cell) **Used to determine the type of chemotherapy that can be administered for treatment *PDL1 testing: **PDL1 is a protein expressed by certain cancer cells allowing them to evade the immune system (“fake mustache analogy”). **Also confirmed by IHC **This protein is targetable! **Often measured as: ***Total protein expression (TPS): The number of positive tumor cells divided by the total number of viable tumor cells multiplied by 100% ***Composite protein expression (CPS): The number of positive tumor cells, lymphocytes and macrophages, divided by the total number of viable tumor cells multiplied by 100% *Molecular testing: **We discuss this in detail in Episode 005 **Genetic information from the tissue sample **Always better to get sample from soft tissue than from bone **Why is this important? ***To be able to identify “driver mutations” ****What is it? Important mutations that may be “driving” oncogenesis ****Many of these have drugs that directly target these mutations Prognostic vs. predictive biomarkers: *Prognostic biomarkers: Mutations or changes that give information about the cancer’s overall outcome regardless of therapy *Predictive biomarkers: Mutations that provide information about how a cancer may respond to a particular drug Cell-free DNA (AKA “liquid biopsy”): *Special tests that can detect microscopic amounts of cancer cell DNA within the patient’s blood which may also be used to find prognostic/predictive biomarkers *Ongoing studies to see if this can be used to find relapse of disease Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCall Instagram: @TheFellowOnCall Listen in on: Apple Podcast, Spotify, and Google Podcast