Leading oncologists emphasize that early biomarker testing has become fundamental to successful perioperative treatment planning for early-stage non-small cell lung cancer (NSCLC), marking a significant shift in treatment approach protocols.
Dr. Ticiana Leal, associate professor and director of the Thoracic Medical Oncology Program at Emory University School of Medicine, highlights how biomarker testing, previously established as crucial in advanced NSCLC, has now proven critical in perioperative and adjuvant settings.
Impact on Treatment Selection
Identification of driver mutations through early biomarker testing can fundamentally alter the treatment trajectory. For patients with specific mutations such as EGFR and ALK, where targeted therapy approvals exist in the adjuvant setting, traditional perioperative chemo-immunotherapy may not represent the optimal approach.
"For some driver mutations such as EGFR and ALK, where we have approvals of targeted therapy in the adjuvant space and that we know immunotherapy is not as effective, a neoadjuvant or perioperative chemo-immunotherapy strategy is not going to be the best therapy," explains Dr. Leal.
Addressing Implementation Challenges
While the importance of early biomarker testing is clear, healthcare systems face practical challenges in implementation. Turnaround time for test results remains a significant barrier. Dr. Leal suggests that reflex testing could serve as an important strategy to optimize and accelerate result delivery.
Multidisciplinary Approach
The complexity of perioperative NSCLC management necessitates a coordinated, multidisciplinary approach. Tumor boards play a vital role in facilitating communication between specialists and ensuring aligned treatment decisions.
At Emory, efforts are underway to establish real-time multidisciplinary clinics, allowing for immediate collaborative discussions and streamlined decision-making. This approach aims to improve patient outcomes through coordinated care delivery and careful tracking of results.
Early Specialist Involvement
Medical oncologists must now see patients earlier in their treatment journey, ideally as soon as biopsy results become available. This early involvement ensures that biomarker testing can inform initial treatment decisions and that all specialists deliver consistent messages regarding treatment approaches.
"It's important that we align the message we're conveying to the patient, so that decision-making conversation is streamlined across the different specialists seeing the patients," Dr. Leal emphasizes.
