Dr. Pennell on the Underutilization of Genetic Testing in Lung Cancer

Nathan A. Pennell, MD, PhD, director, Lung Cancer Medical Oncology Program, Cleveland Clinic Taussig Cancer Institute, discusses the underutilization of genetic testing in lung cancer.

Genetic testing is not used as commonly as it should be, says Pennell. Approximately 70% to 80% of patients in the United States are being tested for EGFR mutations, and less than half of patients with advanced disease are being tested for other mutations, Pennell adds. Additionally, the majority of patients are still getting single-gene tests rather than comprehensive next-generation sequencing. Patients are being tested for EGFR, ALK, and ROS1 sequentially rather than at the same time, and it doesn't cost much more to test for every actionable gene than it does to test for a single actionable gene, explains Pennell. Notably, sequential testing becomes more difficult after the first couple of tests because there's a significant drop-off in the availability of tissue with which to perform the testing, adds Pennell.

A publication from the University of Colorado reported that the median survival of patients with ALK-positive disease at their institution ranged from 7 and 8 years. Moreover, Pennell has a patient with ALK-positive NSCLC who is now 11 years out from their diagnosis on targeted therapy. Such outcomes would not be possible without the use of genetic testing. To account for these mutations, patients should undergo reflex testing at the time of their diagnosis, Pennell concludes.