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Blood test benefits poor prognosis lung cancer patients

A blood test could improve the clinical management of advanced non-small cell lung cancer (NSCLC) patients who are considered unsuitable for chemotherapy.

Non-small cell lung cancer (NSCLC) accounts for about 80-85% of all lung cancers with many patients not diagnosed until cancer is at an advanced stage. For patients with a good level of health (classed as ECOG Performance Status (PS) 0-1), several effective treatment options are available, including chemotherapy and immunotherapies. However, those with poor levels of health (classed as ECOG PS 2-4), often because they are older or have multiple medical problems, have fewer treatment options. In the 2018 UK National Lung Cancer Audit Annual Report, the most comprehensive analysis of lung cancer patients, 41% of the 39,199 patients in the UK were classified as having a poor level of health and were expected to only live for about 4 months on average.

The research team evaluated a commercially available blood test VeriStrat (from Biodesix, USA) within the TOPICAL trial, in which patients had their blood samples taken and tested. Patients were classified as either VeriStrat Good or VeriStrat Poor. The study found that patients classified as VeriStrat Good lived longer, on average, than those classified as VeriStrat Poor. The median survival was over 50% greater (4.6 vs 2.9 months). VeriStrat testing is able to provide patients with a more accurate prognosis, by identifying those that live longer than expected despite appearing to be in poor health.

Professor Siow Ming Lee, Professor of Medical Oncology (UCL), Consultant Medical Oncologist (UCLH) and Chief Investigator of the study, said: “We had conducted the TOPICAL trial only among patients who were considered not fit enough to have standard chemotherapy, and received active supportive care. We wanted to see whether we could identify a subgroup of patients with better outcomes than expected, who might then be managed differently by their doctor in terms of treatment options.”

Professor Lee continued: “The relationship between the VeriStrat test and survival is a major finding within this patient population who have generally poor health and are difficult to treat. It was striking that 1 in 13 patients classified as VeriStrat Good lived as long as 2 years from diagnosis, compared with none who were classified as VeriStrat Poor. The VeriStrat test seems to distinguish patients who have a shorter or longer survival. This has never been reported before in this particular patient group.”

“The value to patients and clinicians is that consideration of their general level of health alone to guide treatment could under-estimate the actual prognosis of some. VeriStrat status could be considered in tandem to provide a better clinical picture. Patients classified as VeriStrat Good could potentially benefit from more aggressive treatment options, using newer generation therapies or selected for experimental treatment trials, and so increase their life expectancy. Whereas VeriStrat Poor patients could be treated more conservatively or be considered for trials of experimental therapies that have low toxicity.”

This work has been supported by Cancer Research UK and the BRC.

Read the research paper: The clinical role of VeriStrat testing in patients with advanced non–small cell lung cancer considered unfit for first-line platinum-based chemotherapyEuropean Journal of Cancer.