Why is genomic testing important for lung cancer patients?
Non-small cell lung cancer (NSCLC) accounts for about 80% to 85% of lung cancers. The main histological (cellular) subtypes of NSCLC are adenocarcinoma, squamous cell carcinoma, or large undifferentiated carcinoma depending on the cell type where the cancer is identified. These subtypes are often grouped together as NSCLC because their treatment and prognoses (outlook) are often similar.
Many NSCLC subtypes also have certain genetic changes that drive tumour growth and can be used as targets for treatments. Targeted treatments only work in NSCLC patients with a target gene variant, so genomic testing (also sometimes referred to as biomarker testing or molecular testing) is needed to determine if someone should receive a certain treatment or not.
Funding for next generation sequencing panels in lung cancer
Leading the way in genomic testing in cancer, people diagnosed with non-squamous NSCLC can now access Medicare-reimbursed Next Generation Sequencing (NGS) to determine treatment options. There has been a large and continually growing number of genetic variants identified that drive NSCLC tumour growth, and accompanying availability of new targeted treatments on the Pharmaceutical benefits Scheme (PBS) and in clinical trials. Sequential testing can delay the commencement of treatment or there may not be sufficient tissue to conduct a test for each genetic variant, and some genetic variants may not be included in testing at all.
Different tests are available but EGFR, BRAF, KRAS, MetExon14, ALK fusion, ROS1, RET and NTRK1, 2 and 3 are to be included in the report. While ERBB2(HER2), is not specifically listed, the availability of HER2 TKIs in the research setting suggests this gene should be routinely tested and included in the report.
Making NGS Standard: TOGA’s Push for Smarter NSCLC Diagnosis
NGS significantly improves the diagnostic process as it maximises the use of tumour tissue available and is faster than sequential testing. TOGA strongly encourages the sequencing and inclusion in the report of all identified targets where there is an option for targeted therapy available, including clinical trials, and PBS-funded treatments.
TOGA has long recognised the importance of improved genetic testing in patient care, and established a national multicentre study in 2020 – The ASPiRATION study, an observational cohort study to assess the clinical impact of upfront comprehensive genomic profiling (CGP) on the management of patients with metastatic NSCLC. Amongst providing other information, ASPiRATION enabled access to testing for the expanded number of genetic variants in a single test for newly diagnosed metastatic NSCLC patients. If a genetic variant was identified, the patient was then offered options to access targeted treatments, such as a clinical trial.
As part of TOGA’s commitment for advocacy on improved patient care TOGA wrote a letter in support for the small gene panel testing application to MSAC and provided feedback on the small gene panel application consultation survey, in support of the application for Medicare funding. TOGA also contacted the PBS to request that the wording for access to several TKIs be amended to include identification of the relevant targetable mutation via NGS, alongside existing diagnostic methods.
To assist with implementation of the small NGS panel, TOGA and the Royal College of Pathologists of Australasia prepared Molecular Testing
of Lung Cancer in Australia- Evidence-Based Best Practice Recommendations 2025.
TOGA, in conjunction with one of its members, is currently undertaking some work to assess the uptake and implementation of NGS testing for NSCLC in Australia. Please contact TOGA on info@thoraciconcology.org.au if you want to be part of this work.
Hear more about the implementation of NGS in an episode of Conversations in Lung Cancer Research.
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