Lung cancer

Genomic testing in lung cancer moves beyond EGFR

Comprehensive genomic profiling (CGP) available through the ongoing ASPiRATION trial is already benefiting patients with lung adenocarcinoma, the Clinical Oncology Society of Australia (COSA) 2022 ASM in Brisbane was told.

Professor Ben Solomon shared a case study of a 37-year-old patient with rapidly progressive disease who was started on standard of care therapy.

Molecular testing with a standard of care panel was negative for the usual suspects including EGFR, ALK and ROS1 however the CGP, performed with DNA and RNA next generation sequencing (NGS), identified a targetable RET fusion.

The patient was switched to the selective RET-directed treatment selpercatinib and was showing a response.

Professor Solomon, co-chair of the ASPiRATION study, told the meeting that it was possible to identify an oncogenic driver in more than half of patients with lung adenocarcinoma and targeted therapies were becoming more available.

“So if we really want to deliver precision medicine, then we need to get the right drug to the right patients at the right time. It is essential that we identify these drivers and try to match the patient to the appropriate therapy.”

He said testing for individual genes sequentially was time consuming, expensive and consumed a lot of tissue. 

The nationwide prospective ASPiRATION study is comparing comprehensive genomic testing in parallel to standard of care testing in 1,000 newly diagnosed, metastatic NSCLC patients. To date, over 600 patients have been enrolled into the study at 17 participating sites.

“Our key aims are to look at the feasibility and clinical impact of comprehensive genomic testing in the Australian context.”

As well, patients can be directed into several therapeutic arms of the study with targeted therapies matched to the identified oncogene driver.

Professor Solomon said many patients were started on standard of care therapy while awaiting their CGP report.

He noted the most common reason identified for failure of the testing process was an insufficient tissue sample.

“This emphasises the importance of ensuring an adequate sample at the time of diagnosis and to rebiopsy if you don’t have adequate tissue,” he said.

The study was also looking to improve the turn-around time which was currently about 4 weeks – similar to what has been described in the US but not ideal.

He said the data to date clearly showed a much greater yield with comprehensive genomic testing than with standard of care testing.

In particular, CGP identified 29 ERBB2 alternations and 8 RET fusions compared to 11 ERBB2 with standard of care testing and no RET fusions. 

Professor Solomon told the limbic that the advantage of comprehensive genomic testing was not just linking patients to existing therapies but linking patients to clinical trials as well.

“I think we want to deliver personalised medicine for lung cancer and the very first step is to characterise the tumour,” he said.

For more information on the trial including remote recruitment, visit the TOGA website.

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