Lung cancer specialized testing in NSCLC:

What do we do if we biopsy a suspected metastatic lesion?

* Immunohistochemistry (IHC):

**Confirm if it is metastatic NSCLC

**Confirms the histology of the NSCLC (such as adenocarcinoma vs. squamous cell)

**Used to determine the type of chemotherapy that can be administered for treatment

*PDL1 testing:

**PDL1 is a protein expressed by certain cancer cells allowing them to evade the immune system (“fake mustache analogy”).

**Also confirmed by IHC

**This protein is targetable!

**Often measured as:

***Total protein expression (TPS): The number of positive tumor cells divided by the total number of viable tumor cells multiplied by 100%

***Composite protein expression (CPS): The number of positive tumor cells, lymphocytes and macrophages, divided by the total number of viable tumor cells multiplied by 100%

*Molecular testing:

**We discuss this in detail in Episode 005

**Genetic information from the tissue sample

**Always better to get sample from soft tissue than from bone

**Why is this important?

***To be able to identify “driver mutations”

****What is it? Important mutations that may be “driving” oncogenesis

****Many of these have drugs that directly target these mutations

Prognostic vs. predictive biomarkers:

*Prognostic biomarkers: Mutations or changes that give information about the cancer’s overall outcome regardless of therapy

*Predictive biomarkers: Mutations that provide information about how a cancer may respond to a particular drug

Cell-free DNA (AKA “liquid biopsy”):

*Special tests that can detect microscopic amounts of cancer cell DNA within the patient’s blood which may also be used to find prognostic/predictive biomarkers

*Ongoing studies to see if this can be used to find relapse of disease

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