Dr Borczuk on Currently Offered Gene Testing for Patients With Lung Cancer

Alain Charles Borczuk, MD, chairman, Department of Pathology and Laboratory Medicine, North Shore University Hospital; chairman, Department of Pathology and Laboratory Medicine, Long Island Jewish Medical Center; professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, discusses gene testing that may be offered for patients with lung cancer.

Borczuk says pathologists at Northwell Health can offer single-gene testing with a rapid turnaround, providing quick results. However, these single-gene tests cannot fully capture the multigene landscape needed to comprehensively categorize a patient’s tumor, according to Borczuk. One potential solution is implementing an algorithm that quickly tests for key markers, delivering results within 48 hours, he suggests. A larger panel could then be considered later, but to standardize this approach, several factors need to be addressed, he emphasizes. First, agreement is required among clinicians, including surgical oncologists, radiation oncologists, and medical oncologists, and sufficient tissue samples must be available for multiple rounds of testing, Borczuk explains.

In cases where the sample is small, decisions must be made upfront to select the most appropriate assay based on the sample size, he continues. This may mean that a full panel cannot be performed, he notes. In such instances, a single-gene test could serve as a salvage protocol, providing high-value, though incomplete, data, Borczuk reports. Although this approach may not offer comprehensive information, it can still inform treatment decisions and prevent the need for a repeat biopsy, he says. The key challenge is standardizing this process across the system, so pathologists understand how to proceed and clinicians know what to expect from data gleaned from smaller samples, he states.

Oncology teams often perform gene testing with smaller panels not due to lack of knowledge but because they best match the sample size, maximizing the information that can be derived, Borczuk expands. This distinction is not always clear to clinicians, and many may misunderstand, believing that a smaller panel was chosen over a full one, when in reality, the sample size made a full panel impossible, he concludes.