As cancer researchers make advances in therapies for some of the hardest to treat cancers, matching the right treatment to each patient is becoming more important. Cancer tumors are biologically distinct from person to person, and the biological makeup of a tumor dictates 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 crucial tool that oncologists are increasingly using to treat their patients.
Cancer biomarkers include proteins, gene mutations (changes), and gene rearrangements. They can be prognostic, indicating how aggressive a cancer might be, or predictive, informing the decisions oncologists make in terms of what 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).
“Cancer biomarkers are like a DNA fingerprint of the tumor,” says Dr. Velcheti, associate professor in the Department of Medicine at NYU Grossman School of Medicine. “Identifying the specific biomarker of the tumor is imperative for developing a good treatment strategy for the patient’s lung cancer.”
Several drugs have been approved by the U.S. Food and Drug Administration (FDA) in recent years to treat people with tumors that contain specific biomarkers. For NSCLC, scientists have identified more than 20 biomarkers. In 2021, clinical trials at 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 mutation.
In his own work with people with NSCLC, Dr. Velcheti has seen biomarkers make a dramatic difference in those with late-stage disease who had little to no hope in terms of standard treatment options. These patients, Dr. Velcheti says, had remarkable outcomes after enrolling in clinical trials using drugs targeted to their specific biomarkers.
People with cancer, particularly those for which biomarkers have been identified, should bring up genetic testing of their tumors with their doctors, Dr. Velcheti says, to determine what their cancer looks like in terms of its genetic makeup and to identify potential treatments that are specific to the type of cancer. At Perlmutter Cancer Center, every patient with lung cancer receives comprehensive genomic profiling of the tumor at the time of diagnosis.
“Comprehensive genomic profiling helps us understand the biology of the cancer much better, so we can develop a treatment paradigm that is very personalized to each patient,” Dr. Velcheti says. “Comprehensive genomic profiling is the standard of care patients should expect from all oncologists.”
Looking ahead, Dr. Velcheti says there are technologies under development that will help oncologists better understand cancers more fundamentally at a biological level. Some of these newer and advanced technologies can analyze levels of protein and mRNA and increase the sensitivity of detecting biomarkers in patients. There also has been a significant shift in terms of how biomarker testing is done.
“The gold standard of biomarker testing is to sequence the tumor’s DNA,” Dr. Velcheti says. “Now, we have approaches where we can actually look for mutations in the tumor’s DNA leaking out of the tumors into the blood.”