Typically, if you have early stage disease, your primary therapy will comprise chemotherapy or radiation, or in certain cases, surgery. After completing your primary therapy regimen, adjuvant  therapy with a targeted drug may be recommended by your clinician based on mutations present in your tumor. Strand’s genetic tests can help determine these mutations. 

EGFR is a gene that is mutated in about 40% of NSCLC. if you are an EGFR positive patient. Strand’s genetic test can identify if your tumor is EGFR positive, and hence determine your suitability for drugs that target the EGFR protein. In case the primary biopsy material is exhausted or not available, it is also possible to assess the tumor’s mutation profile via a blood test, also known as a liquid biopsy. Tumor cells shed a tiny amount of their DNA into the blood and Strand’s liquid biopsy test can pick up mutations from a blood sample. This test involves a simple blood draw, in a manner very similar to other standard blood tests.

One of the genes commonly mutated in NSCLC is EGFR. If you are an EGFR-mutation positive patient and have stopped responding to TKIs, Strand’s genetic tests can help understand why this may be happening and in certain cases suggest other drugs that may work better.

A fresh biopsy post recurrence is needed for this test. In case a fresh biopsy is not possible, it is also possible to assess the tumor’s mutation profile via a blood test, also known as a liquid biopsy.

Tumor cells shed a tiny amount of their DNA into the blood and Strand’s liquid biopsy test can pick up mutations from a blood sample. This test involves a simple blood draw, in a manner very similar to other standard blood tests. 

There has been much progress in recent years in understanding the molecular nature of NSCLC. This has led to the development of a number of therapeutic options for advanced NSCLC, in addition to chemotherapy and radiation. The graph above shows the genes that are most commonly seen to be mutated in NSCLC. Strand’s genetic tests on your biopsy can be used to profile your tumor DNA for all these genes to identify which, if any, is the molecular driver of your disease.. This information can then be used by your clinician to prescribe the right treatment regimen for your cancer. We offer NSCLC-specific tests that encompass all the genes relevant for this tumor type.

Another class of drugs which is being increasingly used in NSCLC is immunotherapy. Immunotherapy drugs help in activation of the immune system so that it can fight the cancer and have been seen to be very effective in certain cases. Immunotherapy can be considered when mutational profiling does not identify key genes with therapeutic targets. There are a few markers for assessing potential  response to immunotherapy. Some of these are PD-L1, MSI (Microsatellite Instability)  and TMB (Tumor Mutational Burden). PD-L1 staining is a test that detects levels of the PD-L1 protein, one of the key players in the regulation of the immune response against cancer.

Microsatellite instability and Tumor Mutational Burden are measures of a tumor’s immunogenicity, or foreignness in a sense, that can be measured by genetic profiling. A high PD-L1, MSI or TMB score indicates that the chances for a favorable response to immunotherapy are higher. Your doctor might order these tests if he or she is considering an immunotherapy regimen for you.

Although NSCLC is the most common type of lung cancer, other lung cancer types such as small cell (or neuroendocrine) lung cancer and mesothelioma can arise in some patients. The genes and mutations that characterize these tumors are not well understood.

The primary mode of treatment for these cancers involves chemotherapy. However it may be useful to profile these tumors with a broad large panel of genes that are mutated across a variety of cancers as there may be a possibility that one of them is also mutated in your tumor. If such a gene is identified, it may open up additional avenues of treatment with targeted therapy. Hence,you and your doctor may consider Strand’s large panel genetic tests for such cancers if you would like to explore other potential treatment options.