Not all lung cancer is the same. Some lung cancers have specific characteristics called biomarkers. Knowing if you have biomarkers can help you and your health care team better understand your lung cancer and determine which treatment options may be best for you.
In this section we will discuss the types of biomarkers commonly found in non–small cell lung cancer (NSCLC), as well as the different treatments that may be available to you if you have a biomarker.
Types of biomarkers
Biomarkers are changes (mutations) in your cancer cells or specific proteins present on cancer cells that can be detected with biomarker testing.
There are 2 types of biomarkers for NSCLC
Biomarkers in NSCLC
Driver Mutations
- Changes in the DNA of cancer cells
- Cause cancer cells to overgrow
Immunotherapy Biomarkers
- May be found on the surface of cancer cells
- Show how cancer cells interact with the immune system
Biomarkers can be measured using a tissue or liquid biopsy
A tissue biopsy is when a small sample of cancer cells is removed from the part of the body where the cancer is located using a needle or surgery. Those cells are then tested to see if any biomarkers are present.
A liquid biopsy is when a sample of blood is collected and tested for biomarkers on cancer cells that are circulating in the blood or for pieces of DNA from cancer cells that are in the blood.
Both tissue and liquid biopsies can be used to test for mutations and biomarkers, although tissue biopsies are used more frequently.
What is a driver mutation, and why is it important?
- A driver mutation is a change in the DNA of cancer cells
- A driver mutation can cause normal cells to become cancer cells
- There are different types of driver mutations and different ways to test for them
- All advanced (stage 4) NSCLC is recommended to be tested for driver mutations
What is an immunotherapy biomarker, and why is it important?
- An immunotherapy biomarker can show how cancer cells interact with the immune system
- PD-L1 is currently the only immunotherapy biomarker with an approved treatment in NSCLC
- PD-L1 is found on the surface of cancer cells. It can stop the immune system from fighting the cancer cells
- All NSCLC is recommended to be tested for PD-L1
- Biomarker testing for PD-L1 is done by staining on the tissue biopsy
- A specialist known as a pathologist will look at your PD-L1–stained sample under a microscope
- The pathologist will look at the amount of PD-L1 staining and determine if your lung cancer is PD-L1 positive
Treatments differ based on the type of biomarker identified
If your lung cancer has a driver mutation, targeted therapy may be an appropriate treatment for you.
- Targeted therapy is designed to block what is causing the cancer to grow
- People who are treated with a targeted therapy based on their unique biomarker:
- May have better treatment outcomes
- May have improved chances of living longer
If your lung cancer has an immunotherapy biomarker, immunotherapy may be an appropriate treatment for you.
- Immunotherapy works to help your body’s own immune system fight the cancer
- Immunotherapy can be used in some cases without completing a biomarker test
There are several treatment options approved to treat people with the following biomarkers:
Driver Mutations With Approved Treatments
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The driver mutation HER2 is an emerging biomarker for NSCLC. Investigational treatments for HER2 are being tested in clinical trials.
Immunotherapy Biomarkers With Approved Treatments
- PD-L1
The driver mutation HER2 is an emerging biomarker for NSCLC. Investigational treatments for HER2 are being tested in clinical trials.
It is very important to talk with your health care team about biomarker testing to find out if your lung cancer has any biomarkers.
To learn more about the types of biomarker testing, continue on to Understanding Types of Biomarker Testing.
Frequently Asked Questions
Why do I need biomarker testing?
Biomarker testing helps identify if you have any biomarkers that may be treated with an approved targeted therapy or if you are eligible for participation in a clinical trial. Studies have shown that people with NSCLC who are treated with a targeted therapy based on their biomarker may have better outcomes than those who are not.
Do I start treatment right away?
When possible, medical experts agree that it is important for people with NSCLC and their health care team to wait until all biomarker testing results are available before making a shared decision on a treatment plan. The use of targeted therapies may lead to better outcomes in people whose NSCLC is positive for driver mutations.
Also, medical experts have found that some NSCLC caused by driver mutations may not respond as well to less-targeted options like immunotherapy. Typically, medical experts recommend that immunotherapy only be used when targeted therapy is not an option. When possible, waiting for all biomarker testing results may allow you and your health care team to better personalize your treatment to your specific lung cancer.
What are my options if I don’t have a biomarker?
Even if the tumor in your body does not have any biomarkers that can be matched to an available targeted therapy or to a clinical trial, comprehensive biomarker testing can still help you and your health care team decide on the right treatment for you. There are treatment options for NSCLC. Speak to your doctor about the best treatment options for you.
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Non–small cell lung cancer (NSCLC)
The most common form of lung cancer, which is described by the way the cancer cells look under a microscope (not small).
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Targeted Therapy
A treatment that targets the driver mutations that cause cancer growth.