Genetic Testing Throughout Disease Course Critical in Lung Cancer

Konstantinos Leventakos, MD

Future research for stage III lung cancer and beyond involves identifying patient populations that respond best to immunotherapy, as well as the discovery of predictive biomarkers, explained Konstantinos Leventakos, MD.

Moreover, Leventakos recommends that all patients receive genetic testing upon a lung cancer diagnosis and throughout the disease course, in an effort to help physicians create the most personalized treatment plan.

“We have a lot of examples of patients where genetic testing showed a genetic aberration for which we had a clinical trial. Therefore, I believe the genetic testing and a good panel of genetic molecules is most important thing to make sure we have personalized medicine,” said Leventakos, an oncologist and assistant professor of oncology at the Mayo Clinic.

In an interview during the 2019 OncLive State of the Science Summit on Non—Small Cell Lung Cancer, Leventakos discussed updates in personalized medicine for patients with stage III lung cancer.

OncLive: How are you using technology to match patients to clinical trials?

Leventakos: We have so many clinical trials and a lot of patients want to take advantage of them. At Mayo Clinic, we have been trying to use artificial intelligence (AI) in a way that the medical records are read by AI and patients are appropriately matched to clinical trials. That is a very powerful tool for us to make sure every patient with lung cancer is appropriately matched to a clinical trial that would be beneficial for them.

Moving on to pivotal data, how has the PACIFIC trial impacted the landscape for stage III lung cancer?

Stage III lung cancer disease is always something that we want to get better [at treating]. With the PACIFIC trial, with the addition of immunotherapy at the end of concurrent chemoradiation, we were able to increase survival, which is very important for the patients. All patients with stage III lung cancer should be eligible for immunotherapy.

What questions do we still have with immunotherapy in stage III lung cancer?

One of the questions that will soon be answered by clinical trials is, “Can we incorporate immunotherapy earlier? What is the optimal duration of immunotherapy?”

There are studies undergoing that [are looking at earlier] integration of immunotherapy, which means before or during concurrent chemoradiation.

How can stage III lung cancer treatment become more personalized?

At Mayo Clinic, every patient gets tested for not only the basic [genes], but an extensive panel of genetic biomarkers so we know if they are good candidates for targeted treatment. At the same time, in my practice I try to, at progression, test again either by blood or tissue biopsy in order to identify biomarkers. That would lead patients to either an FDA-approved treatment or [potentially enroll them on an] appropriate clinical trial.

How does the utility of liquid biopsies compare with that of tissue biopsies?

Many times, when we cannot have access to tissue or the patient cannot [undergo a tissue] biopsy, I have been using [liquid biopsies]. It is still to be considered whether we can use them for monitoring disease, but with technology getting better, it will be a tool of huge importance.

What is one aspect of your care that you wish was publicized more?

It is important for more genetic testing to be done throughout the disease course, because I personally believe that lung cancer is an ever-changing disease. I always feel better when I have a recent genetic understanding of what is going on with the disease. That is why I'm a fan of liquid biopsies and further testing.