Nasser H. Hanna, MD, Tom and Julie Wood Family Foundation Professor of Lung Cancer Clinical Research, professor of medicine, Indiana University School of Medicine, discusses his approach to biomarker testing in lung cancer. 

All patients with stage IV lung adenocarcinoma should undergo baseline molecular testing irrespective of smoking history, says Hanna. The selected molecular panel should test for 

 amplification, Hanna says. Additionally, emerging targets, such as 

 fusions, should be tested for, Hanna adds. 

Typically, newly diagnosed patients undergo immunohistochemistry (IHC) testing to confirm the disease histology, says Hanna. After IHC staining, if the patient has available tissue left, tissue-based biomarker testing should be performed. If the patient does not have available tissue, plasma-based molecular testing may suffice in identifying actionable alterations, Hanna says. Additionally, waiting for the molecular testing results to come back before initiating therapy should be standard practice, Hanna adds.

Specifically, immunotherapy should not be recommended before the results of molecular testing are returned because patients with 

 mutations, for example may not have an optimal response to immunotherapy even if their tumor is PD-L1 positive, says Hanna. In some instances, such as for patients with 

 V600E–mutant lung cancer, immunotherapy may be preferred despite the presence of an actionable alteration, Hanna explains. 

Generally, the commercially available sequencing platforms for tissue- and liquid-based testing are comparable, concludes Hanna. 

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Nasser H. Hanna, MD, discusses his approach to biomarker testing in lung cancer.  



Dr. Hanna on Approaching Biomarker Testing in Lung Cancer 

Nasser Hanna, MD, Tom and Julie Wood Family Foundation Professor of Lung Cancer Clinical Research, at Indiana University Melvin and Bren Simon Cancer Center, discusses the efficacy of consolidation immunotherapy in patients with stage III non—small cell lung cancer (NSCLC).

Prior to the phase III PACIFIC trial, the standard of care for this patient population had not changed for almost 2 decades, Hanna says. In February 2018, durvalumab (Imfinzi) became the first checkpoint inhibitor to gain FDA approval for the treatment of patients with unresectable NSCLC with the goal of reducing the risk of cancer progression. Durvalumab is indicated for patients whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy.

In the PACIFIC trial, over 700 patients with inoperable stage III NSCLC were given chemotherapy and radiation and were then randomized 2:1 to receive adjuvant durvalumab every 2 weeks for 1 year or adjuvant placebo given intravenously every 2 weeks for 1 year. Patients who were treated with durvalumab had a median progression-free survival of 16.8 months versus 5.6 months for those who received placebo.

Prior to these data, Hanna says, it was long established that concurrent chemotherapy with radiation was the standard for patients with stage III NSCLC. For 20 years, trials evaluating induction immunotherapy, targeted agents, and other strategies were not successful at improving overall survival. The positive data from PACIFIC trial changed practice, establishing a new standard of care.

Nasser Hanna, MD, Tom and Julie Wood Family Foundation Professor of Lung Cancer Clinical Research, at Indiana University Melvin and Bren Simon Cancer Center, discusses the efficacy of consolidation immunotherapy in patients with stage III non–small cell lung cancer.

Nasser Hanna, MD

Articles

Dr. Hanna on Approaching Biomarker Testing in Lung Cancer

Dr. Hanna on Consolidation Immunotherapy in Stage III NSCLC