Researchers at the University of California Davis have determined that surgical biopsies can be safely performed on select patients with late-stage non-small cell lung cancer, which should enhance their access to drugs that target specific genetic mutations such as epidermal growth factor receptor (EGFR).
The findings, published recently in The Journal of Thoracic and Cardiovascular Surgery,1 address the common problem in treatment for advanced lung cancer, namely insufficient tumor tissue available for molecular analysis.
“We will be allowing more people to be eligible for clinical trials, and ultimately that will provide value to the patient and access to treatments they may not have had otherwise,” said David T. Cooke, MD, lead author of the study and Assistant Professor and Head of General Thoracic Surgery at UC Davis Medical Center.
In many cases of late-stage lung cancer, surgical biopsy is deemed too dangerous, so less invasive approaches are used, including fine-needle aspiration and core-needle biopsies.
“With clinical trials of new targeted therapies, an exhausting level of testing is performed,” Dr. Cooke said. “With less invasive biopsies, sometimes there is not enough volume of cells collected to do the molecular testing.”
Dr. Cooke and colleagues retrospectively examined the records of 25 patients whose cases were discussed at a multidisciplinary thoracic oncology conference or clinic and who had known or suspected stage IV non-small cell lung cancer. All elected to have surgical biopsies, most of which were done using video-assisted thoracic surgery.
Of the cases, five experienced a complication; three of them were minor. Surgical biopsy led to the identification of potentially targetable molecular information in more than half, with 10 of the 25 patients also determined to be eligible for enrollment into a therapeutic targeted clinical trial. “Patients who have been reviewed in a multidisciplinary manner and determined that less invasive biopsies might not be successful, could be appropriate for surgical biopsy, even at stage IV,” Dr. Cooke said. He emphasized that the approach should only be used when the case has been reviewed by a team of experts, including a pulmonologist, radiologist, surgeon, and medical oncologist, and the best biopsy strategy is selected.
“I think this will change the game,” he said. “It will empower thoracic surgeons to work closely with multidisciplinary tumor boards and participate in the care of patients with late-stage lung cancer.”
Other study authors included David R. Gandara, MD, Philip C. Mack, MD, Primo N. Lara, Jr, MD, and Elizabeth A. David, MD, all of UC Davis; Royce F. Calhoun, MD, formerly of UC Davis and now with Rideout Health; and Neal C. Goodwin, MD, formerly of Jackson Laboratory-West and now with Champions Oncology, Inc. ■
Disclosure: No potential conflicts of interest were reported.
1. Cooke DT, Gandara DR, Goodwin NC, et al: Outcomes and efficacy of thoracic surgery biopsy for tumor molecular profiling in patients with advanced lung cancer. J Thorac Cardiovasc Surg 148:36-40, 2014.