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Necessity of genetic testing for non-small cell lung cancer (NSCLC)

Detection of high throughput gene can be a variety of types of disposable mutation detection of multiple gene, synchronous parsing targeted therapy, chemotherapy and genetic risk, comprehensive guide individualized treatment of patients with colorectal cancer, patients may benefit maximization.

  • Targeted Drugs Matching

    As research on lung cancer driver genes continues, more driver genes are discovered, and they are closely related to targeted therapies. With the development of high-throughput next generation sequencing (NGS) technology, sequencing costs have dropped significantly, providing favorable conditions for cancer precision management.

  • Drug Resistance Monitoring

    Lung cancer patients will inevitably acquire drug resistance after targeted treatments with small-molecule medicines. The formation of drug resistance stems from constant mutations of tumor cells. Repeatedly taking tumor tissues for drug-resistance associated mutation test is inconvenient in clinical practice. Therefore, ctDNA based liquid biopsy provides a non-invasive and convenient way to obtain genetic status for assessing patients’ drug resistance and helping physicians adjust treatment plans.

  • Chemotherapy Drug Efficacy and Side-effects Assessment

    Chemotherapy is an important strategy for cancer treatment when targeted therapy is not available. The sensitivity of tumors to chemotherapy drugs varies among patients and can be predicted through testing chemotherapy-related genetic status in peripheral blood specimens (PBTS). This allows the selection of appropriate drug and dosage for effective treatment and best outcomes.

  • Clinical Trial Enrollment

    There are over 10 approved drugs for lung cancer, and more are still in clinical trials. Using NGS, it is possible to test and analyze whether patients carry gene mutations eligible for drugs in clinical trials, giving them hope for new effective therapies.

  • Targeted Drugs Matching

    As research on lung cancer driver genes continues, more driver genes are discovered, and they are closely related to targeted therapies. With the development of high-throughput next generation sequencing (NGS) technology, sequencing costs have dropped significantly, providing favorable conditions for cancer precision management.

  • Drug Resistance Monitoring

    Lung cancer patients will inevitably acquire drug resistance after targeted treatments with small-molecule medicines. The formation of drug resistance stems from constant mutations of tumor cells. Repeatedly taking tumor tissues for drug-resistance associated mutation test is inconvenient in clinical practice. Therefore, ctDNA based liquid biopsy provides a non-invasive and convenient way to obtain genetic status for assessing patients’ drug resistance and helping physicians adjust treatment plans.

  • Chemotherapy Drug Efficacy and Side-effects Assessment

    Chemotherapy is an important strategy for cancer treatment when targeted therapy is not available. The sensitivity of tumors to chemotherapy drugs varies among patients and can be predicted through testing chemotherapy-related genetic status in peripheral blood specimens (PBTS). This allows the selection of appropriate drug and dosage for effective treatment and best outcomes.

  • Clinical Trial Enrollment

    There are over 10 approved drugs for lung cancer, and more are still in clinical trials. Using NGS, it is possible to test and analyze whether patients carry gene mutations eligible for drugs in clinical trials, giving them hope for new effective therapies.

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Guidelines on Genetic Testing for NSCLC

The guidelines point out that for advanced NSCLC, especially for non-squamous NSCLC, routine genetic tests should be performed for EGFR/ALK/ROS1 gene mutations. For mutation-positive tumors, TKI targeted drugs are recommended as first-line treatment. For tumors with EGFR activating mutations, gefitinib, erlotinib and afatinib are recommended as first-line treatment. Compared with chemotherapy, targeted therapies show better efficacy and fewer side effects.

For patients with TKI-resistance and tumor progression, the guidelines require the testing of EGFR T790M mutation. For patients with T790M-positive and disease progression, osimetinib (AZD9291) is recommended, and for patients with T790M mutation and slow tumor progression, osimetinib can be used in combination with local treatment, or patients may continue to use TKI but should switch to osimetinib after disease progresses.

In the National Comprehensive Cancer Network’s 2017 guidelines for non-small cell lung cancer, patients are further classified. For advanced NSCLC, three new first-line treatment options are proposed. The first option is targeted therapy based on driver gene mutations, which is most preferred. The second one is to test PD-L1 expression when EGFR/ALK/ROS1 mutations are absent- if PD-L1 is overexpressed in tumor tissues (≥ 50%), treatment with PD-1 antibody Keytruda is recommended. The third one is first-line chemotherapy for patients without any indications mentioned above.

For patients with ALK fusion mutation, the guidelines recommend crizotinib as first-line therapy. If disease progresses after using crizotinib, ceritinib or alectinib can be used as alternatives.

For patients with ROS1 rearrangement, crizotinib is recommended as first-line therapy. If disease progresses, chemotherapy or immunotherapy with PD-1 antibody may be considered.

For patients with PD-1 overexpression (≥ 50%) whose EGFR/ALK/ROS1 mutations are negative, PD-1 antibody Keytruda is recommended as first-line therapy, and chemotherapy can be used after disease progresses.

In advanced NSCLC patients, PD-1 antibody treatment can be used for patients whose tumors demonstrate PD-1 over expression (≥ 50%), and patients whose chemotherapy or targeted therapy fail in second-line and third-line treatment.

For the treatment of advanced lung cancer patients, molecular classification is becoming increasingly important in the guidelines, showing that genetic testing based precision medicine is the trend for lung cancer treatment.

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