Current challenges in applying gene-driven therapies in clinical lung cancer practice

Abstract

Over the last twenty years, with the development of gene-driven therapies, numerous new drugs have entered clinical use. Very few of these new drugs are suitable for a large number of patients, and all require molecular genetic testing. In lung cancer, gene-targeted therapy has evolved rapidly and has placed demands on the development of diagnostics and tissue sample preparation and logistics. Rapid diagnosis and prevalence assessment are necessary to determine the prognosis of a lung cancer patient based on the latest research findings. Therefore, the molecular-genetic diagnostic pathway must also be accelerated and matured to do the necessary analyses on small samples. Because lung cancer rebiopsy can be difficult, liquid biopsy techniques should be developed to cover more of the treatable mutations. There are obstacles related to tissue sampling, new genomic techniques and access to gene-driven cancer drugs, including their affordability. With this review and case study, we go into the obstacles faced by our clinic and discuss how to tackle these obstacles in lung cancer. We use lung cancer as an example due to its complexity, though these same obstacles are found in different cancers on a minor scale.

Keywords: Cancer drug; Availability; Gene testing; Tissue sampling; Lung cancer

Core Tip: Several gene-driven therapy drugs and molecular testing, together with immunohistochemistry, have evolved for lung cancer in recent years. Lung cancer is mutation dense and has more predictive genes that potentially influence treatment decisions than any other cancer type. In our case study, we ran into obstacles and delays in the diagnostic pathway both in tissue sampling and in gene testing. However, the major obstacle was the financial availability of new drugs. All elements need to be in place before a new drug can be given to patients, following the idea of the right drug at the right time.