Barriers to Using Targeted Therapy in NSCLC


At the 23rd Annual Perspectives in Thoracic Oncology meeting, Joshua M. Bauml, MD, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, discussed the role of targeted therapy in NSCLC and some of the barriers to using this treatment approach.




There are a couple of barriers that affect how we use targeted therapies in non‑small cell lung cancer. The first and perhaps most important one is access to testing. When you have a patient and they come in with a new diagnosis of non‑small cell lung cancer, particularly non‑squamous non‑small cell lung cancer, it is essential that we get testing done.

The testing that I feel is the most tissue efficient for most patients with non‑squamous cancers is a next‑generation sequencing assay which does, in massively parallel techniques, allow us to look at hundreds, even thousands of genes at the same time.

It's difficult for patients to get access to that because it requires often their clinician to say, "Yes, I know you have a diagnosis of cancer, but we need to wait to get this other information."

For a symptomatic patient, that's sometimes just not feasible, but for asymptomatic patients, it's important that the physicians tell the patients about this opportunity to get this information, to ensure they get the correct testing.

Once the testing is complete, for patients who have more common alteration, things like EGFR or even ALK, ROS‑1, BRAF, for which there are FDA approved treatments, the answer is pretty straightforward. You can give someone one of these FDA approved treatments.

What we're now seeing are new highly active targeted therapies in rare tumor subtypes, for instance, RET translocation, N-TREK translocation. These are things where we have fantastic drugs in development that are not FDA approved.

In that situation, if a patient has one of the genetic alterations, it is absolutely critical that we help that patient identify a clinical trial so they can get one of these new drugs, which really does have substantial efficacy and a very good tolerability profile generally speaking.


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