Keith Kerr, BSc, MB, ChB, consultant pathologist, University of Aberdeen, Aberdeen, Scotland, discusses common misconceptions with molecular profiling in lung cancer.

It is a common idea that molecular testing is a one-dimensional approach, focusing only on mutations. As a result, researchers have developed state-of-the-art technology for analyzing mutations at a DNA level. However, there is much more when it comes to profiling a patient, Kerr argues. Along with mutations, fusion genes have emerged as important molecular factors. Global strategies for detecting mutations are generally not sufficient enough to detect these fusions. Kerr says there is evidence for some alterations with a fusion gene present that the key biomarker is the presence or absence of the protein. Pan-genomic analyses at a DNA level are not capable of identifying this.

Kerr concludes that molecular profiling strategies should not be one dimensional; rather, it should involve multiple complimentary strategies.

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Dr. Kerr on Misconceptions With Molecular Profiling in Lung Cancer

Keith Kerr, BSc, MB, ChB, FRCPath, FRCPE, of the University of Aberdeen, Aberdeen, Scotland, discusses patient selection for immunotherapy in lung cancer.

Patient selection for immunotherapy is a controversial topic, says Kerr. The community is concerned that PD-L1 is not the ideal biomarker and many oncologists would prefer not to have to select patients at all and just give PD-1 inhibitors to everyone, says Kerr.

However, this is unrealistic, for both medical and financial reasons, he says. If you look at healthcare on a global scale, it is not going to be feasible or practical to give these drugs to everyone, and so the search for a more effective biomarker must continue.

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Dr. Keith Kerr on Selecting Patients for Immunotherapy in Lung Cancer

Keith Kerr, BSc, MB, ChB, FRCPath, FRCPE, of the University of Aberdeen, Aberdeen, Scotland, discusses PD-L1 immunohistochemistry in lung cancer.

Right now the only biomarker with validated data in lung cancer is PD-L1 immunohistochemistry. It is perceived as not being a good biomarker, but it is unfairly judged says Kerr.

It often gets compared to EGFR mutation or ALK translocation which are very effective biomarkers, but PD-L1 is not the only controlling factor within the immune response and it will never have the level of predictive power as those biomarkers. Expectations of PD-L1 need to be downgraded, says Kerr.

However, it can be improved. Right now each PD-L1 inhibitor has its own immunohistochemistry test and they are not all the same. It is not practical to do multiple test, so there needs to be simplification, says Keer.

​Keith Kerr, BSc, MB, ChB, FRCPath, FRCPE, of the University of Aberdeen, Aberdeen, Scotland, discusses PD-L1 immunohistochemistry in lung cancer.

Keith Kerr, BSc, MB ChB

Articles

Dr. Kerr on Misconceptions With Molecular Profiling in Lung Cancer

Dr. Keith Kerr on Selecting Patients for Immunotherapy in Lung Cancer

Dr. Keith Keer on PD-L1 in Lung Cancer