Alan B. Sandler, MD, begins the conversation on the best practices and guidelines in non-small cell lung cancer (NSCLC) by saying that he tests all tumors by the Sequenom System or Ion Torrent. For practice purposes, Sandler suggests following NCCN guidelines, which is to test all patients for the EGFR mutation and EML4-ALK, regardless of smoking history.

Mark A. Socinski, MD, echoes Sandler and adds that actionable molecular findings are EGFR mutations and EML4-ALK translocations. In his practice, Socinski also tests for BRAF, KRAS, and RET to identify patients for clinical trials; however a drug for those subsets is not currently approved.

Corey J. Langer, MD, comments on the amount and quality of a core biopsy. He says that while the amount of tissue matters, the cellularity of the tissue is more important.

Anne S. Tsao, MD, says that, in the right hands, risk to the patient is minimalized with CT-guided interventional core biopsies of the lung. In addition, endobronchial-guided, ultrasound-guided biopsies are becoming standard practice and good tissue can be biopsied from the mediastinum. Tsao says she will not do bone biopsies as it’s difficult to get enough tumor tissue.

View Part II of the discussion