Navigating Biomarker Testing: A Checklist for Each Stage of your Journey

It may be difficult to know which questions to ask and when in comes of biomarker testing-sometimes called genetic, genomic or molecular testing. Comprehensive biomarker testing is an important part of your lung cancer treatment journey. It helps your doctor and care team understand the makeup of your tumor, which can guide treatment decisions. Below are some key questions and actions to take as you navigate your care.

For more information about comprehensive biomarker testing, visit Lung.org/biomarker-testing.

If your doctor suspects you might have lung cancer:

• Asking them to take enough tissue out during the biopsy for “comprehensive next generation sequencing (NGS), or comprehensive biomarker testing” is especially important for someone with lung cancer as it signals to your provider that you want to be tested for multiple biomarkers at one time, and may help identify the best treatment for your cancer.
• Before your biopsy, ask your doctor to collect enough tumor tissue for comprehensive next generation sequencing (NGS), also called comprehensive biomarker testing.
  • Testing for only one, two, or three biomarkers at a time may miss important treatment options. NGS testing allows your doctor to test for multiple biomarkers at once, which is especially important for patients with lung cancer.

If your doctor tells you that you have lung cancer:

• Confirm your tumor tissue is being tested for biomarkers using next-generation sequencing (NGS).
• If your doctor says NGS testing has not been done, ask why. Some common reasons include:
  • Not enough tumor tissue was able to be safely removed. In this case, ask your doctor if they intend to do a new tissue biopsy.
  • You have a type of lung cancer where it is not indicated to do NGS.
• Ask your doctor if he/she intends to do a liquid biopsy (a blood test). This can provide some results why you wait for the NGS testing or provide information if your doctor was unable to do a tissue biopsy.
• Ask and confirm with your doctor if your tumor’s PD-L1 levels will be tested, as this can provide information about how you may respond to immunotherapy.
• Ask your doctor if it is possible to delay starting immunotherapy while you wait for the biomarker test results to come back.

When it is time to discuss treatment:

• Ask your doctor to review all test results with you. 
• Confirm you have been tested for all relevant biomarkers for lung cancer and ask how the test results affect your treatment options.
• Ask your doctor about the goal of the treatment, what you can expect in terms of side effects and how well the treatment will work. Share with your doctor what is most important to you during this time.
• Connect with an oncology social worker to discuss how you are feeling emotionally and if you have any concerns about paying for your care.
• Considering asking to connect with a palliative care/supportive care doctor to help you manage your side effects and improve your quality of life.
• Connect with support networks like the Lung Cancer Survivors Community on Inspire or request a mentor to help guide you through your journey.

When it is time to change your treatment:

• Over time, your cancer may start to grow despite your current treatment, and a change in your treatment may be necessary. Ask your doctor if you need a liquid biopsy (a blood test) or tissue biopsy is needed to guide your next treatment decision.
• Ask your doctor to review all new test results and discuss the pros and cons of your treatment options.

Navigating cancer care and treatment decisions can be overwhelming. The most important thing is to have all of the information possible about your cancer and a trusting relationship with your doctor and care team. Support resources, such as oncology social workers, palliative care doctors and even other patients can help you along the way. You are not alone.

Speak to one of our experts at the Lung Helpline if you have questions about lung cancer and learn more about resources available. We are here to help.