Prima

Lung Cancer

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Prima

Lung Cancer

Alarming scenario of cancer in India*

  • An estimated 14.5 lakh people are living with cancer in India
  • Over 7 lakh new cases being registered every year
  • Over 8.8 lakh deaths will be due to cancer by 2020
  • Cancers of breast, lung and cervix will top the list

* National Cancer Registry Program - ICMR

Lung cancer in India is rising*

  • Lung cancer continues to be the commonest cancer in Indian males
  • There is an alarming rise in the incidence of lung cancer in women as well
  • It represents 13% of all new cancers in India, with 1.8 million new cases recorded in 2012
  • Lung cancer is the most common cause of death from cancer, with 1.6 million deaths (19.4% of all cancer-related deaths)
Mixtures
Large Cell
Carcinomas
Squamous Cell
Carcinomas
Adenocarcinomas
(Bronchioloalvelor Carcinoma)
Small Cell
Lung Cancer (SCLC)

Prima

MedGenome’s comprehensive offering of the most advanced genetic and molecular tests for cancer management

Advanced testing techniques in Prima

Advanced testing techniques in Prima Advanced testing techniques in Prima Advanced testing techniques in Prima

How Molecular and Genetic Testing help?

  • Ability to sub-classify the type of cancer
  • Disease prognostication (assessment of survival and response to treatment)
  • Theranostic Value (Finding the best targeted drugs - alleviating unnecessary chemotherapy and radiation)
  • Hereditary cancer risk assessment

Single gene tests offered within Prima

Single gene tests offered within Prima

Gene Panel tests offered within Prima

Gene Panel tests offered within Prima

Lung Cancer Types

Lung Cancer Types

Types Lung Cancer by Histology

Gene Panel tests offered within Prima

Effect of molecular testing for non small cell lung cancer patients.

20006
Graph
20006
Graph

Molecular testing is the first step to suitable treatment

Mutations or specific changes present in a particular tumor are defined by molecular markers. Here’s a breakdown of the most common lung cancer mutations:

Lung Cancer Types
Gene Panel tests offered within Prima

Chan and Hughes 2015. Translational Lung Cancer Research, Vol 4, No 1.

Representative driver oncogenes in lung adenocarcinoma

(Kohno et al. Transl Lung Cancer Res 2015;4(2):156-164)

East Asia

Representative driver oncogenes in lung adenocarcinoma East Asia

USA/Europe

Representative driver oncogenes in lung adenocarcinoma USA/Europe

Targetable oncogenic drivers in NSCLC

Targetable oncogenic drivers in non-small-cell lung cancer

Gene Alteration Frequency (%) Targeted Therapies
EGFR Mutation 10-15 Erlotinib, gefitinib, afatinib, CO-1686, AZD9291
BRAF Mutation 3-4 Dabrafenib, trametinib, dasatinib
PI3KCA Mutation 1-3 BKM120, XL147
HER2 Mutation 1-4 Afatinib, neatinib, dacomitinib
ELM4-ALK,
KIF5B-ALK,
TFG-ALK
Fusion 3-5 Crizotinib, LDK378, CH5424802
ROS1 Fusion 1-2 Crizotinib
RET Fusion 1-2 Cabozantinib, vandetanib

MedGenome’s Prima solutions for molecular and genetic evaluation of lung cancer

EGFR Testing solutions

EGFR
Mutation by PCR
on Tumor tissue
Mutation by PCR
on Blood
OncoFocus
T790M
By NGS on
Blood
OncoTrack
EGFR
By NGS on
ct DNA in Blood
+ NRAS, KRAS
BRAF
Somatic Mutation Analysis in Tumor Tissue 56 genes
Hereditary Cancer Panel Germline Mutations in Blood 100 genes
OncoTrack Ultima Somatic Mutation Analysis in Blood 56 Genes
Hereditary Cancer Extended Panel Germline Mutations in Blood 300 Genes

OncoTrack when compared to PET/CT

OncoTrack
With OncoTrack, clinicians can overcome some of the limitations that exist while using PET/CT as a diagnostic tool.
OncoTrack
Further to being expensive when compared to OncoTrack, PET/CT gives limited insights into the cause and lack of response to a treatment.
OncoTrack
OncoTrack enables a clinician to monitor the progress of a treatment outcome at regular intervals with a simple blood test.

OncoTrack test applications

A one-shot blood test to monitor drug response status for NSCLC and CRC patients

  • It is a minimally invasive blood test to monitor patients during the initiation of therapy (baseline) and at regular intervals (follow-up) for assessment of development of ‘drug resistant’ mutations
  • It facilitates early detection of emergent genetic alterations that can be associated with resistance to therapy during cancer progression. (Example: T790M in NSCLC)
  • This test is designed to sequence regions of oncogenes: EGFR, KRAS, NRAS and BRAF.
  • These genetic alterations help in designing personalised therapy for cancer patients

Benefits of liquid biopsy to a lung cancer patient

  • Non-Invasive test to monitor response to drugs
  • Evaluate emergence of drug resistance
  • Early prediction of recurrence and relapse
  • Prevents potential complications of tissue biopsy
  • Alleviates cumbersome tissue biopsy procedure
  • Unmasks tumor heterogeneity which may not be detected on tissue biopsy
  • It is cheaper

When to prescribe OncoTrack (Liquid Biopsy over Tissue Biopsy)

  • When tumor site makes it difficult to obtain a tissue biopsy
  • When patient is frail and wishes to avoid biopsy
  • When tumor appears hyper mutated and tumor heterogeneity can result in biased opinion on tissue biopsy
  • Biopsy tissue is insufficient or inadequate for molecular testing
  • Blood sample collection does not need clinical skills of performing Lung biopsy

Therapeutics using Liquid Biopsy with OncoTrack

  • It is a minimally invasive blood test to monitor patients during the initiation of therapy (baseline) and at regular intervals (follow-up) for assessment of clinical response to the treatment
  • It facilitates early detection of emergent genetic alterations that can be associated with resistance to therapy during cancer progression
  • This test is designed to sequence regions of oncogenes: EGFR, KRAS, NRAS and BRAF, which are somatically altered recurrent mutations in solid tumors with role in targeted therapy
  • This test also screens for novel mutations that has relevance in targeted therapy; and are in pipeline for approval as well as in clinical trials

OncoTrack is based on NGS technology

  • High sensitivity and ability to detect low frequency mutations
  • Unlike other techniques, NGS has the advantage of multi-gene profiling in a single assay providing information on the exon covering the HOTSPOT mutation
  • Massively parallel sequencing, which provides data with high confidence and greater accuracy
  • High throughput enables a faster turnaround time
  • Enables sequential testing over long periods of time without any limited material (tumour tissue) constraints
  • Ability to identify the exact mutation, especially for insertion and deletion cases
KRAS
Exons 2,3 & 4
BRAF
Exons 11 & 15 (V600E)
NRAS
Exons 2,3,& 4
EGFR
Exons 18, 19, 20 & 21
Includes T790M & C797S mutation which indicates resistance to EGFR TKI treatment

Benefits of testing with Prima

  • Comprehensive gene range covers wider spectrum of cancer types
  • Targets 18 cancers including benign or malignant tumors
  • Helps identify familial cancer risks based on mutations in specific genes
  • Multiple gene analysis offers a wider risk assessment of cancer and thus is cost effective

Other sources for EGFR testing

  • FFPE Blocks
  • FFPE tumor tissue (3-4mm sections containing upto 70% of the tumor content as verified by the pathologist)
  • DNA (1μg high quality DNA) extracted from tumor tissue

The Liquid Biopsy - test process

1.
OncoTrack
Order Streck tubes from MedGenome Labs 48 hours before Liquid Biopsy. Tubes will be dispatched to you at room temperature.
2.
OncoTrack
Carry out the liquid biopsy as shown, and collect the samples using 20 ml syringe
3.
OncoTrack
Contact the local MedGenome representative to arrange for shipping to the laboratory.
4.
OncoTrack
Leave the filled tubes in the box at room temperature till collection for transport (Temp: 6° C - 36° C)
OncoTrack
Do not store in a refrigerator or freezer

Checklist details

(must send the following along with the liquid biopsy specimen)

  • TRF completed and signed
  • Previous tissue biopsy report
  • Molecular testing report on tissue biopsy, if any
  • Treatment history: treatment naïve/on treatment/completed treatment
  • Last PET-CT report
  • Please mention in the TRF if it is first time evaluation/follow-up evaluation
  • If it’s a follow-up evaluation, please enclose the previous ctDNA report

Turnaround time

Time taken for the generating a clinical report will be maximum of 4 weeks for NGS

In case where the sample quality is poor (sample which fails our QA/QC), the TAT will get prolonged.

New batch of sample needs to be submitted for sequencing and analysis.

References

  1. Ferlay J, Soerjomataram I, Ervik M, Forman D, Bray F. Globocon 2012; Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. Int J Cancer. 2014 Sep 13. Back to cited text no. 1
  2. Center for Disease control and prevention. Significant decreases reported in annual lung cancer rates. J Am Med Assoc 2014; 311:792. Back to cited text no. 2
  3. Takiar R, Nadayil D, Nandakumar A. Projections of number of cancer cases in India (2010-2020) by cancer groups. Asian Pac J Cancer Prev 2010; 11:1045-9. Back to cited text no. 3
  4. Vanita N, Pinnati R, Joshi A, Patil VM, Prabhash K. Lung cancer in the Indian subcontinent. SAJC. 2016;5:95–103.
  5. Parikh PM, Ranade AA, Govind B, et al. Lung cancer in India: Current status and promising strategies. South Asian Journal of Cancer. 2016;5(3):93-95.
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Free Genetic Counselling

Free Genetic Counselling

Actia offers all your patients FREE pre & post-test genetic counselling with our expert and certified genetic counsellors.

Best available support for your patients and families via

  • Latest technologies
  • Helpful customer service
  • Clear result interpretation
  • Counselling sessions with our Genetic Counsellors
Dial 1800 103 3691
diagnostics@medgenome.com

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