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Surveyed European Oncologists Indicate that Predictive Biomarkers that Identify Patients Most Likely to Respond to Therapies Are a Clear Advantage for Costly Oncology Drugs

Decision Resources Group finds that biomarker driven prescribing is likely to positively influence perceptions of oncology drugs for both oncologists and payers. Drawing on insights from over 300 surveyed medical oncologists and 15 interviewed payers across the EU5 (FranceGermanyItalySpain, and the United Kingdom), the findings reveal that although an increase in biomarker testing is seen as a likely future event, the incorporation of additional biomarker tests (e.g. PD-L1 expression for non-small-cell lung cancer) into the diagnosis could prove challenging in cost-conscious countries like ItalySpain, and the United Kingdom. Overall, however, surveyed physicians and interviewed payers are universal in their opinion that the market access of a costly novel agent would be significantly aided by the presence of a companion biomarker test. 

Surveyed Oncologists Indicate that the Use of Biomarker Testing is Increasing Rapidly in Non-Small-Cell Lung Cancer in China and South Korea

Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that, for the treatment of non-small-cell lung cancer (NSCLC), biomarker testing is already widely employed in the China and South Korea markets, and is set to increase to European levels in the next two years.

Boehringer Ingelheim to Sponsor the Bonnie J. Addario Lung Cancer Foundation’s Efforts to Promote Genetic Biomarker Testing

The Bonnie J. Addario Lung Cancer Foundation (ALCF) and Boehringer Ingelheim Pharmaceuticals, Inc. (BI) recently announced that BI will sponsor ALCF’s efforts to raise awareness about the importance of immediate genetic biomarker testing for patients with advanced non-small cell lung cancer (NSCLC).

Personalizing Lung Cancer Care Through Biomarker Testing

The concept of personalized medicine – matching a patient’s unique genetic profile with an appropriate and more individualized treatment plan – is transforming the care of patients with cancer.

Over the last decade, the scientific community has gained a greater understanding of genetic mutations, or abnormalities, associated with the development and progression of cancer; these mutations are also known as biomarkers. The presence or absence of a biomarker can help physicians determine the most appropriate treatment approach for each individual patient based on their specific type of cancer.

In some cancers, like breast cancer, testing for biomarkers is already an established best practice.

However, for other cancers, the regular use of biomarker testing is still gaining momentum; non-small cell lung cancer (NSCLC) is one example.

NSCLC is the most common type of lung cancer – in fact, about 85 percent of patients with lung cancer are diagnosed as having NSCLC. Today, there have been multiple biomarkers identified and believed or known to play a role in the development and progression of this disease. One of these biomarkers is a mutation in a protein known as epidermal growth factor receptor (EGFR); it is one of the most common biomarkers identified in NSCLC patients. Another biomarker being closely studied in NSCLC is anaplastic lymphoma kinase (ALK) rearrangements. Approximately 10 to 15 percent of patients with advanced non-small cell lung cancers have EGFR mutations, while another two to seven percent have ALK rearrangements.

There have been significant advancements in the research of NSCLC over the past 10 years including increased knowledge of biomarkers, which can inform treatment decisions.

Traditional surgery, radiation and chemotherapy, which can remove or kill some normal cells along with cancer cells, were once the only options; however, targeted therapies are now an option for some patients who have a biomarker. Targeted therapies generally work by influencing the processes that control growth, division, and spread of cancer cells, as well as the signals that cause cancer cells to die naturally (apoptosis), the way normal cells do when they are damaged or old.

“The discovery of genetic mutations and the process of testing for them – known as biomarker testing – is changing the diagnosis and treatment landscape for patients with cancer,” said Kevin Lokay, vice president and business unit head, Oncology, Boehringer Ingelheim Pharmaceuticals, Inc. “It allows us to determine if a patient’s cancer is associated with a genetic mutation, leading to a more detailed diagnosis and giving us the tools we need to map out an individualized treatment approach for each patient.”

Ideally, biomarker testing happens immediately after a patient is diagnosed with a disease like lung cancer to help ensure that he or she can start on the most appropriate treatment as early as possible.

A team – that may include pulmonologists, pathologists, oncologists and other health professionals – typically works together in the diagnosis and treatment of patients with lung cancer, including biomarker testing. There are multiple steps involved in biomarker testing for patients with advanced NSCLC, including:

  • Taking a sample of lung tissue from a patient
  • Analyzing/confirming type of lung cancer
  • Testing the tissue sample for biomarkers
  • Determining an individualized treatment approach

What can you do? You can increase the awareness of biomarker testing. If you or a loved one is diagnosed with lung cancer, be empowered by asking about biomarker testing. You can learn more about the biomarker testing process via an easy-to-understand brochure titled, “Individualizing Your Lung Cancer Care: Informing Decisions Through Biomarker Testing,” which can be found on http://onebreath.org and was developed by Boehringer Ingelheim in collaboration with the American College of Chest Physicians (ACCP) and EmergingMed.

Healthcare professionals involved in the care of patients with lung cancer can find out more through Boehringer Ingelheim’s Let’s Test initiative (www.LetsTestNow.com) to learn more about the importance of automatically testing for biomarkers in advanced NSCLC and the importance of a multidisciplinary, collaborative approach to testing.

Source: Idaho State Journal

Urine Biomarker Test Can Diagnose as well as Predict Rejection of Transplanted Kidneys

A breakthrough non-invasive test can detect whether transplanted kidneys are in the process of being rejected, as well as identify patients at risk for rejection weeks to months before they show symptoms, according to a study published in The New England Journal of Medicine (NEJM).

By measuring just three genetic molecules in a urine sample, the test accurately diagnoses acute rejection of kidney transplants, the most frequent and serious complication of kidney transplants, says the study’s lead author, Dr. Manikkam Suthanthiran, the Stanton Griffis Distinguished Professor of Medicine at Weill Cornell Medical College and chief of transplantation medicine, nephrology and hypertension at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

“It looks to us that we can actually anticipate rejection of a kidney several weeks before rejection begins to damage the transplant,” Dr. Suthanthiran says.

The test may also help physicians fine-tune the amount of powerful immunosuppressive drugs that organ transplant patients must take for the rest of their lives, says Dr. Suthanthiran, whose laboratory developed what he calls the “three-gene signature” of the health of transplanted kidney organs.

“We have, for the first time, the opportunity to manage transplant patients in a more precise, individualized fashion. This is good news since it moves us from the current one-size-fits-all treatment model to a much more personalized plan,” he says, noting that too little immunosuppression leads to organ rejection and too much can lead to infection or even cancer.

Given the promise of the test first developed in the Suthanthiran laboratory at Weill Cornell and previously reported in NEJM, the National Institutes of Health (NIH) sponsored a multicenter clinical trial of nearly 500 kidney transplant patients at five medical centers, including NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian/Columbia University Medical Center. The successful results of that trial are detailed in the July 4 issue of NEJM.

Such a test is sorely needed to help improve the longevity of kidney transplants and the lives of patients who receive these organs, says study co-author Dr. Darshana Dadhania, associate professor of medicine and medicine in surgery at Weill Cornell Medical College and associate attending physician at NewYork-Presbyterian Hospital.

Dr. Dadhania says that the primary blood test now used to help identify rejection — creatinine, which measures kidney function — is much less specific than the three-gene signature.

“Creatinine can go up for many reasons, including simple dehydration in a patient, and when this happens we then need to do a highly invasive needle-stick biopsy to look at the kidney and determine the cause. Our goal is to provide the most effective care possible for our transplant patients, and that means individualizing their post transplant care,” she says. “Using an innovative biomarker test like this will eliminate unnecessary biopsies and provide a yardstick to measure adequate immunosuppression to keep organs — and our patients — healthy.”

Although a number of researchers have tried to develop blood or urine-based tests to measure genes or proteins that signify kidney organ rejection, Dr. Suthanthiran and his research team were the first to create a gene expression profile urine test — an advance that was reported in NEJM in 2001 and, with an update also in NEJM, in 2005.

The research team measured the levels of messenger RNA (mRNA) molecules produced as genes are being expressed, or activated, to make proteins. To do this, they developed a number of sophisticated tools to measure this genetic material. “We were told we would never be able to isolate good quality mRNA from urine,” he says. “Never say never.”

He and his colleagues found that increased expression of three mRNAs can determine if an organ will be, or is being, rejected. The mRNAs (18S ribosomal (rRNA)–normalized CD3ε mRNA, 18S rRNA–normalized interferon-inducible protein 10 (IP-10) mRNA, and 18S rRNA) indicate that killer T immune cells are being recruited to the kidney in order to destroy what the body has come to recognize as alien tissue.

The signature test consists of adding levels of the three mRNAs in urine into a composite score. Tracked over time, a rising score can indicate heightened immune system activity against a transplanted kidney, Dr. Suthanthiran says. A score that stays the same suggests that the patient is not at risk for rejection.

“We were always looking for the most parsimonious model for an organ rejection biomarker test,” Dr. Suthanthiran says. “Minimizing the number of genes that we test for is just more practical and helps to give us a clearer path towards diagnosis and use in the clinic.”

Physicians can tailor a patient’s use of multiple immunosuppressive drugs by lowering the doses steadily, and monitoring the patient’s composite score over time. Any increase would suggest a somewhat higher dose of therapy is needed to keep the organ safe.

“This is akin to monitoring blood glucose in a patient with diabetes,” Dr. Suthanthiran says. “Because different people have different sensitivity to the two-to-four immunosuppressive drugs they have to take, this test offers us a very personalized approach to managing transplantations.”

Predicting rejection weeks before it happens

The clinical trial began in 2006 with participation from five medical centers — NewYork-Presbyterian/Columbia University Medical Center, the University of Pennsylvania’s Perelman School of Medicine, the Northwestern University Feinberg School of Medicine, the University of Wisconsin School of Medicine and Public Health and NewYork-Presbyterian/Weill Cornell Medical Center, which contributed 122 of the total 485 kidney transplant patients.

The gene-expression studies were led by Dr. Suthanthiran with his laboratory serving as the Gene Expression Monitoring (GEM) core and the clinical trial was led by Dr. Abraham Shaked, director of the PENN Transplant Institute at the Perelman School, on behalf of the Clinical Trials in Organ Transplants 04 (CTOT-04) Study Investigators. The GEM core was blinded to the clinical status of the patients including their biopsy results and the data collection and analysis were performed by an independent statistical center sponsored by NIH.

Researchers collected 4,300 urine specimens during the first year of transplantation, starting at day three post-transplantation. The urine samples were shipped to the GEM core at Weill Cornell Medical College, where analysis of the urine revealed that the three gene-based biomarkers signature could distinguish kidney recipients with biopsy confirmed rejection from those whose biopsies did not show signs of rejection or who did not undergo a biopsy because there was no clinical sign of rejection.

The researchers used the signature to derive a composite score and identify a threshold value indicative of rejection. This score accurately detected transplant rejection with a low occurrence of false-positive and false-negative results. “It is about 85 percent accurate, which is much higher than the creatinine test used today,” Dr. Suthanthiran says. Investigators then validated the diagnostic signature by obtaining similar results when they tested a set of urine samples collected in a separate CTOT clinical trial.

Dr. Suthanthiran anticipates conducting another NIH-funded clinical trial to test whether the signature test can be used to personalize individual immunosuppressive therapy. He says that NIH is also interested in submitting the test to the federal Food and Drug Administration for approval.

These studies have provided enough information that many medical centers can test their own kidney transplant patients for rejection using the publicly-available formula for the biomarker test. Dr. Suthanthiran also is working to develop a way for patients to submit samples via mail for biomarker testing, and avoid an office visit. The study was supported by NIH grants UO1AI63589 and R37AI051652, the Qatar National Research Foundation (NPRP 08-503-3-111) and by a Clinical and Translational Science Center Award (UL1TR000457, to Weill Cornell Medical College).

Study: Urinary-Cell mRNA Profile and Acute Cellular Rejection in Kidney Allografts

Source: Weill Cornell Medical College