Dr. Pennell on Considerations for Immediate Treatment in Lung Cancer

Nathan A. Pennell, MD, PhD, director, Lung Cancer Medical Oncology Program, Taussig Cancer Institute, Cleveland Clinic, discusses the considerations when choosing therapy for patients with lung cancer who need immediate therapy but have not received the results of their molecular testing.

Sometimes in practice, patients diagnosed with lung cancer have received PD-L1 assay results but not molecular testing results because genomic testing takes longer to process, explains Pennell. In other scenarios, there may not be enough tissue for molecular testing. To avoid the situation, Pennell recommends trying to streamline the process within the institution and incorporate plasma testing for faster results.

If patients need to start therapy before receiving the molecular testing results, treatment options need to be considered carefully. The consequence of missing an oncogenic driver can be significant and cause the patient to miss out on potentially life-saving therapy, says Pennell. Patients with oncogenic drivers are much more likely to benefit from immunotherapy versus patients without drivers. If a patient is later found to have a molecular driver but first receives immunotherapy, they must wait months before the drug exits their system, concludes Pennell.