Surgical biopsies can be safely performed on selected patients with late-stage lung cancer

Researchers at UC Davis have determined that surgical biopsies can be safely performed on select patients with late-stage non-small cell lung cancer, which should enhance their access to drugs that target specific genetic mutations such as epidermal growth factor receptor (EGFR).

The findings, to be published in the July issue of The Journal of Thoracic and Cardiovascular Surgery, address a common problem in treatment for advanced lung cancer: insufficient tumor tissue available for molecular analysis, which is required before prescribing targeted therapy.

"We will be allowing more people to be eligible for clinical trials, and ultimately that will provide value to the patient and access to treatments they may not have had otherwise," said study lead author David T. Cooke, assistant professor and head of general thoracic surgery at the UC Davis Medical Center.

In many cases of late-stage lung cancer, surgical biopsy is deemed too dangerous, so less invasive approaches are used, including fine needle aspiration and core needle biopsies.

"With clinical trials of new targeted therapies, an exhausting level of testing is performed," Cooke said. "With less invasive biopsies, sometimes the volume of cells collected is insufficient to do the molecular testing."

Cooke and colleagues retrospectively examined the records of 25 patients whose cases were discussed at a multidisciplinary thoracic oncology conference or clinic and who had known or suspected stage IV non-small cell lung cancer. All elected to have surgical biopsies, most of which were done using video-assisted thoracic surgery, a procedure that requires general anesthesia but only small incisions.

Of the cases, five experienced a complication; three of them were minor. Surgical biopsy led to the identification of potentially targetable molecular information in 19 of the 25 patients, and changed the treatment strategy in more than half, with 10 of the 25 also determined eligible for enrollment into a therapeutic targeted clinical trial.

"Patients who have been reviewed in a multidisciplinary manner and for whom less invasive biopsies were not likely to be successful, could be appropriate for surgical biopsy, even at stage IV," Cooke concluded.

Cooke emphasized that the approach should only be used when the case has been reviewed by a team of experts, including a pulmonologist, radiologist, surgeon and medical oncologist, and the best biopsy strategy is selected.

"I think this will change the game," he said. "It will empower thoracic surgeons to work closely with multidisciplinary tumor boards and be participatory in the care of late-stage lung cancer patients."