AAs cancer researchers make advances in therapies for some of the most difficult-to-treat cancers, it’s increasingly important to find the right treatment for each patient. Cancer tumors are biologically different from person to person, and the biological makeup of a tumor determines how well it will respond to treatment. Cancer biomarkers – biological molecules generated by tumors or the body that indicate the presence of cancer – are a critical tool that oncologists are increasingly using to treat their patients.
Cancer biomarkers include proteins, gene mutations (changes), and gene rearrangements. They can be prognostic and indicate how aggressive a cancer may be, or predictive, and inform the decisions oncologists make in terms of which treatment might work best for patients.
Vamsidhar Velcheti, MD, director of the Thoracic Medical Oncology Program at NYU Langone Health’s Perlmutter Cancer Center, uses cancer biomarkers to care for people with non-small cell lung cancer (NSCLC).
“Biomarkers for cancer are like a DNA fingerprint of the tumor,” says Dr. Velcheti, an associate professor in the Department of Medicine at NYU Grossman School of Medicine. “Identifying the specific tumor biomarker is necessary for developing a good treatment strategy for the patient’s lung cancer.”
In recent years, several drugs have been approved by the US Food and Drug Administration (FDA) to treat people with tumors that contain specific biomarkers. For NSCLC, scientists have identified more than 20 biomarkers. In 2021, clinical trials at the Perlmutter Cancer Center played a role in the approval of two new therapies for NSCLC: amivantamab, which targets EGFR exon 20 insertion mutations, and sotorasib, for people with NSCLC whose tumors have a KRAS-G12C have a mutation.
In his own work with people with NSCLC, Dr. Velcheti saw that biomarkers make a dramatic difference in people with late-stage disease who had little to no hope in terms of standard treatment options. These patients, says Dr. Velcheti, had remarkable results after participating in clinical trials of drugs targeting their specific biomarkers.
People with cancer, especially those for whom biomarkers have been identified, should discuss genetic testing of their tumors with their doctors, says Dr. Velcheti, to determine what their cancer looks like in terms of its genetic makeup and to identify potential treatments specific to the type of cancer. At Perlmutter Cancer Center, every patient with lung cancer receives a comprehensive genomic profiling of the tumor at the time of diagnosis.
“Extensive genomic profiling helps us understand the biology of the cancer much better so that we can develop a treatment paradigm that is very personal to each patient,” said Dr. Velkheti. “Extensive genomic profiling is the standard of care patients should expect from all oncologists.”
Looking ahead, says Dr. Velcheti said there are technologies in development that will help oncologists understand cancer at a more fundamental biological level. Some of these newer and advanced technologies can analyze protein and mRNA levels and increase the sensitivity of detecting biomarkers in patients. There has also been a significant shift in the way biomarker testing is conducted.
“The gold standard for biomarker testing is to sequence the tumor’s DNA,” says Dr. Velkheti. “Now we have approaches where we can actually look for mutations in the tumor’s DNA that leak from the tumors into the blood.”