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My evolving views on molecular testing in advanced NSCLC


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My evolving views on molecular testing in advanced NSCLC

December 28th, 2012 - by Dr. Jack West

http://blog.lungevity.org/2012/12/28/my ... ced-nsclc/

Here’s a video I just did that describes my changing perspective on molecular testing for markers such as EGFR and KRAS mutations and ALK rearrangements. In it, I describe how I’ve been struck by a higher yield for molecular testing in my own clinic patients over the past couple of months than I’ve expected to see, including my finding some “actionable” markers that have led to important treatment shifts in some patients I might have considered to be relatively unlikely to harbor a mutation.

Although it would be nice to be able to define a clear, knowable rule for who to test and what to expect, the reality is that we’re learning so much, so quickly, that I feel it’s most appropriate to acknowledge that our early conclusions are based on limited information, and that we’re gaining new insights based on an ever-growing body of evidence as we test and treat more and more patients with molecularly targeted agents. And this should lead us to be inclined to review what we think we know, assess whether the new information supports or refutes our current perspective, and potentially change that view to better accommodate what we’re learning in real time.

I hope this is helpful and interesting. I hope it’s NOT just unsettling to get a glimpse that betrays that even specialists can have changing approaches over time. The truth is that when we’re still learning a lot, we should all recognize that nobody should offer dogmatic answers, and we should be eager to both learn more and incorporate that new evidence into evolving practices. It’s wonderful to be living through such dynamic times in molecular oncology, where new markers are being detected and new treatments being tested all the time, but it also means that the ground is always shifting below us. Because of that, we need to be nimble and not too entrenched where we are.

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