Lung Cancer

There are 2 main types of lung cancer:

  • Non-small cell lung cancer (NSCLC) which account for 80% to 85% of lung cancer
  • Small cell lung cancer (SCLC) which account for 10% to 15% of lung cancer[1]
For NSCLC, several driver mutations have been identified and drugs have been developed and approved by FDA to specifically target these mutations (as shown in the pie chart). Research has been ongoing in identification of potential actionable molecular biomarkers and also in development of effective targeted therapies that match the mutations.

Frequency of mutations and available targeted therapies approved by FDA in NSCLC[2]

Mutations of most of the epidermal growth factor receptor (EGFR) have been inhibited successfully with Tyrosine Kinase Inhibitors (TKIs such as gefitinib and erlotinib). The exceptions are insertion mutations in exon 20 and the T790M substitution, which correlate with resistance to these drugs. FDA has recently approved the use of Osimertinib for the treatment of patients with EGFR T790M mutation. FDA has also approved the use of Crizotinib for ALK and ROS1 fusions[2].

Identification of mutations in genes such as BRAF and KRAS is important in planning treatment as these genes have been associated with decrease sensitivity to gefitinib (BRAF and KRAS) and erlotinib (KRAS)[2-3].

Oncode offers a range of next-generation sequencing (NGS) panels for lung cancer from smaller panels like Lung LiquidPinpoint panel to comprehensive panels.

ONCODEcipher Lung LiquidPinpoint
ONCODEcipher Lung LiquidPinpoint is a NGS panel targeting 5 most important genes that are frequently mutated in lung cancer, given as EGFR, ALK, BRAF, NRAS and KRAS using only the blood of the patients.

Specimen Requirements:
15ml blood in Streck tubes

Turn Around Time:
10 working days

Shipment Requirement:
Keep specimen at room temperature. DO NOT ship on ice or dry ice or expose to direct sunlight.

ONCODEcipher Lung Liquid28
ONCODEcipher Lung Liquid28 is a NGS panel that delivers information on a variety of treatment-informative mutations in the 28 genes which are known to play a role in cases of NSCLC using only the blood of the patients.

Specimen Requirements:
15ml blood in Streck tubes

Turn Around Time:
10 working days

Shipment Requirement:
Keep specimen at room temperature. DO NOT ship on ice or dry ice or expose to direct sunlight.

ONCODEcipher Lung Comprehensive
ONCODEcipher Lung Comprehensive is a targeted NGS panel that simultaneously detects and characterizes single nucleotide polymorphisms (SNVs) and insertions and deletions (indels) in 67 genes associated with solid tumours.

Specimen Requirements:
• FFPE block OR 10 FFPE Slides (10µm thick sections) with at least 30% tumour cellularity
• 1 H&E stained slide cut from same block

Turn Around Time:
10 working days

Shipment Requirement:
Keep specimen at room temperature. DO NOT ship on ice or dry ice or expose to direct sunlight.
ONCODEcipher Lung Extended
ONCODEcipher Lung Extended is a targeted NGS panel targeting 36 genes commonly mutated in solid tumours for fusion (ALK, ROS, MET, RET etc.) and mutation (EGFR, KRAS, NRAS, BRAF, ALK etc.).

Specimen Requirements:
• FFPE block OR 10 FFPE Slides (10µm thick sections) with at least 30% tumour cellularity
• 1 H&E stained slide cut from same block

Turn Around Time:
10 working days

Shipment Requirement:
Keep specimen at room temperature. DO NOT ship on ice or dry ice or expose to direct sunlight.
ONCODEcipher MSI
Microsatellites are short, tandemly repeated DNA sequences from 1-6 base pairs in length. Microsatellite markers can be used to detect a form of genetic instability called Microsatellite Instability (MSI). MSI is a consequence of germline or somatic inactivation of mismatch repair (MMR) deficient. Loss or down-regulation of the expression of the protein products of these genes results in failure of the DNA mismatch repair system.

Earlier studies have suggested that metastatic colorectal cancer patients with high levels of MSI indicates a better prognosis and is more sensitive to immunotherapy (pembrolizumab). Recent studies have shown that MSI is also a useful indicator for predicting response to immunotherapy in any solid tumour type[2].

ONCODEcipher MSI test is a PCR and fragment analysis assay to detect the increase in length of the microsatellite segment by comparing microsatellite allele size variations between normal and tumour samples in five mononucleotide repeat markers (BAT-25, BAT-26, NR-21, NR-24 and MONO-27) and two pentanucleotide repeat marker (Penta C and Penta D).

Specimen Requirements:
Tumour FFPE block OR 10 FFPE Slides (10µm thick sections) with at least 30% tumour cellularity & 1 H&E stained slide cut from same block AND
Non-Tumour 3ml blood in EDTA tube OR FFPE Block OR 10 unstained Slides (10µm thick sections) of non-tumour tissue

Turn Around Time:
10 working days

Shipment Requirement:
Keep specimen at room temperature. DO NOT ship on ice or dry ice or expose to direct sunlight.
References:
1. Cancer Research UK (2017). Lung Cancer. READ MORE
2. Lovly ,C., Horn, L. & Pao, W. (2016). Molecular Profiling of Lung Cancer. My Cancer Genome. READ MORE
3. Roberts, P.J. & Stinchcombe, T.E. (2013). KRAS Mutation: Should We Test for It, and Does It Matter? Journal of Clinical Oncology 31:8, 1112-1121.