Dr Seetharamu on Current Platforms Utilized for Molecular Testing in Lung Cancer

Nagashree Seetharamu, MD, MBBS, associate professor, medicine, Division of Hematology, Medical Oncology, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, discusses currently utilized platforms and workflows for molecular testing in lung cancer at Northwell Health.

Northwell Health employs a reflexive testing pathway that initiates once the pathologists receive a sample, with different platforms used depending on whether the disease is early stage or advanced stage, Seetharamu begins. Communication between the pathologists and the clinicians is crucial, as it can be difficult for the pathologists to determine the stage of a patient’s disease based solely on the biopsy location, she states, adding that cases where the biopsy comes from a primary lung site or a metastatic spot can be particularly challenging. However, if a sample comes from a liver or adrenal biopsy, it may not require additional clinical information, she notes.

In early-stage lung cancer, Northwell Health focuses on detecting mutations in EGFR and ALK, as these are key biomarkers that guide treatment decisions, Seetharamu says. Although insurance may not always cover comprehensive molecular testing for early-stage disease, the goal is to expedite the identification of these mutations so that neoadjuvant therapy can be initiated without delay, she explains. Both EGFR and ALK testing are now performed in-house for early-stage disease, allowing for rapid turnaround times, which are critical when starting treatment, Seetharamu states.

For advanced stages of disease, molecular testing is typically outsourced, although efforts are underway to bring this process in-house, Seetharamu continues. Currently, Northwell Health uses DNA-based methods for mutation detection. However, if there is a strong suspicion that a mutation may have been missed, the sample will be sent for RNA-based testing, she says. Additionally, Northwell Health conducts in-house testing for certain targetable proteins, depending on tissue availability, Seetharamu notes. Tissue quantity remains a key limiting factor, as comprehensive testing depends heavily on having enough tissue from the biopsy to run these necessary tests, Seetharamu concludes.