Blood test benefits for poor prognosis lung cancer patients

Non-small cell lung cancer (NSCLC) accounts for about 80-85% of all lung cancers. But many patients are not diagnosed until their cancer is at an advanced (late) stage. For advanced patients with a good level of health (classed as ECOG Performance Status (PS) 0-1), several effective treatment options are available, including chemotherapy and immunotherapies. However, those with a poorer level of health (classed as ECOG PS 2-4) have fewer treatment options, most are treated with active supportive care. In the 2018 UK National Lung Cancer Audit Annual Report, the most comprehensive analysis of lung cancer patients, 41% of the 39,199 patients in the UK newly diagnosed were classified as having a poor level of health. They are expected to only live for about 4 months on average.

A patient population with unmet need

The research team evaluated VeriStrat (a commercially available blood test from Biodesix, USA) within the TOPICAL trial, in which patients had their blood samples taken and tested. Patients were classified as either VeriStrat Good or VeriStrat Poor. The trial team found that patients classified as VeriStrat Good lived longer, on average, than those classified as VeriStrat Poor. The median survival was over 50% greater (4.6 vs 2.9 months). VeriStrat testing is able to provide patients with a more accurate prognosis, by identifying those that live longer than expected despite appearing to be in poor health.

“Poor performance patients are a significant population with unmet need, representing over a third of advanced stage NSCLC patients. We had conducted the TOPICAL trial only among patients who were considered not fit enough to have standard chemotherapy, and received active supportive care. We wanted to see whether we could identify a subgroup of patients with better outcomes than expected, who might then be managed differently by their doctor in terms of treatment options,” explains Professor Siow Ming Lee, Professor of Medical Oncology (UCL), Consultant Medical Oncologist (UCLH) and Chief Investigator of the study.

Refining patient prognosis

“The relationship between the VeriStrat test and survival is a major finding within this patient population who have generally poor health and are difficult to treat. It was striking that 1 in 13 patients classified as VeriStrat Good lived as long as 2 years from diagnosis, compared with none who were classified as VeriStrat Poor. The VeriStrat test seems to distinguish patients who have a shorter or longer survival. This has never been reported before in this particular patient group,” says Professor Lee.

“The value to patients and clinicians is that consideration of their general level of health alone to guide treatment could under-estimate the actual prognosis of some. VeriStrat status could be considered in tandem to provide a better clinical picture. Patients classified as VeriStrat Good could potentially benefit from more aggressive treatment options, using newer generation therapies or selected for experimental treatment trials, and so increase their life expectancy. Whereas VeriStrat Poor patients could be treated more conservatively or be considered for trials of experimental therapies that have low toxicity.”

This work has been supported by Cancer Research UK and the UCL Hospitals Biomedical Research Centre.

Further information

• Research paper: The clinical role of VeriStrat testing in patients with advanced non–small cell lung cancer considered unfit for first-line platinum-based chemotherapy. European Journal of Cancer
• National Lung Cancer Audit, Royal College of Physicians
• TOPICAL trial: First-line erlotinib in patients with advanced non-small-cell lung cancer unsuitable for chemotherapy (TOPICAL): a double-blind, placebo-controlled, phase 3 trial. Lancet Oncology
• Professor Siow Ming Lee academic profile
• Professor Allan Hackshaw academic profile
• Cancer Research UK & UCL Cancer Trial Centre
• NIHR UCLH Biomedical Research Centre
• VeriStrat proteomic blood test
• ECOG Scale of Performance Status 
• Main image: Wikimedia Commons. Credit: Jeremy L. Grisham