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Lung Cancer Genomic Testing (EGFR, KRAS, ALK, BRAF)

Neethu Sheri Kurian

Content Specialist

4baseCare

Lung Cancer Genomic Testing is based on identifying mutations in your genes- which is the basis of all cancers.

Genes are segments of DNA that dictate how your body functions. They contain instructions on how to make proteins, which in turn control bodily functions. Sometimes genes mutate; they accumulate changes that may affect how cells work-they can prevent damaged DNA from repairing itself and cause uncontrolled cell growth and division- which can eventually lead to tumor formation and cancer.When these gene mutations cause abnormal cell growth in the lungs, they contribute to lung cancer.

Are mutations always hereditary?

According to the National Cancer Institute, only about 5-10% of lung cancer cases are due to hereditary mutations. These mutations are passed on in families, from parent to offspring through an egg or sperm.

The remaining 90% of the mutations are acquired; they occur due to exposure to damaging substances throughout a lifetime such as tobacco, chemicals, and viruses.

How are these mutations detected?

Lung cancer mutated genes can be detected by Lung Cancer Genomic Testing. Also known as Biomarker Testing, this test involves detailed studies of biomarkers on tumor tissue obtained from a biopsy or blood sample (For more on biopsy in lung cancer, read our blog Liquid Biopsy – a new ally for Lung Cancer Treatment).

Biomarkers are molecules such as proteins, hormones, or pieces of DNA, released by cancer cells or the body in response to cancer. These substances are detected in higher-than-normal levels in the blood, urine, or tissues of some people with cancer.

Biomarkers can also refer to mutations, changes, or patterns in a tumor’s DNA.

There are two main types of lung cancer biomarkers:

  1. Mutations: These are changes or rearrangements in genes that can promote the growth of cancer cells.
  2. Immune response biomarkers: These can predict a patient’s response to immunotherapy.

What are some important biomarkers that I need to know about?

KRAS, EGFR, ALK, and BRAF are some important biomarkers.

KRAS(Kirsten rat sarcoma viral oncogene homolog): KRAS is a gene that plays a role in cell growth and division. Mutations in KRAS are detected in about 30% of NSCLC cases and are most commonly found in the adenocarcinoma type of NSCLC. It’s more common in people who smoke and presents a poorer outlook for patients.

EGFR (Epidermal growth factor receptor): The EGRF protein is present on the surface of cells and helps in cell growth and division. But when it is present in excessive amounts, it hastens cell growth, causing cancer. EGFR mutations are seen in 10-15% of lung cancers and are more common in women and nonsmokers.

ALK (Anaplastic lymphoma kinase): Mutations in the ALK gene allow cancer cells to grow and spread. They are detected in about 5% of NSCLC cases, commonly in younger people and nonsmokers.

BRAF(v-raf murine sarcoma viral oncogene homolog B1): Mutations in the BRAF gene cause the production of an abnormal protein that encourages cancer cell growth. BRAF mutations are found in 3.5%–4% of NSCLC cases. Half of these are of the BRAF V600E subtype. These mutations are common in current or former smokers.

Why should I get my biomarkers tested?

Knowing your biomarkers enables your doctor to diagnose your cancer accurately and predict disease progression. It also lets your doctor choose the best treatment for you and monitors treatment efficacy in real time.

In the past, everyone with lung cancer received the same treatment despite mutational differences. This resulted in side effects and variations in treatment efficacy. But now, knowing a patient’s biomarkers enables doctors to prescribe Targeted therapy, which mitigates these issues.

For instance, a study showed that EGFR mutations respond better to EGFR tyrosine kinase inhibitors when compared to drugs such as gefitinib and erlotinib.

Your biomarker testing will identify specific biomarkers of your tumor and decide the course of your treatment. Depending on the results, you may be prescribed targeted therapy alone or in combination with another targeted therapy, chemotherapy, or other lung cancer treatments.

The test can also identify driver mutations when they are present, which are mutations that are the primary cause of cancer.

If you have a particular driver mutation and the FDA has approved targeted therapy drugs against the mutation, then you will be prescribed that. Apart from this, biomarker testing also predicts how well your cancer will respond to targeted therapy. Targeted therapy dramatically improves patient outlook and reduces side effects.

Below are some FDA-approved targeted therapies for common mutations seen in Lung Cancer:

  • Sotorasib (Lumakras) for KRAS mutations
  • Dacomitinib (Vizimpro), Erlotinib (Tarceva), Gefitinib (Iressa), Amivantamab (Rybrevant), Mobocertinib (Exkivity), Osimertinib (Tagrisso), Afatinib (Gilotrif), etc. for EGFR mutations
  • Alectinib (Alecensa), Brigatinib (Alunbrig), Ceritinib (Zykadia), Crizotinib (Xalkori), Lorlatinib (Lorbrena) for ALK mutations.
  • Dabrafenib (Tafinlar), Trametinib (Mekinist) for mutations in BRAF V600E

In addition to the above benefits, Genomic Testing also assesses the risk of hereditary Lung Cancer, which has implications for your family members, including future generations. (For more on the advantages and importance of Biomarker Testing in Lung Cancer, check out our blogs- Why Is Lung Cancer Biomarkers Testing Important? and How Biomarker Testing Has Improved Clinical Outcomes for Lung Cancer Patients )

Where can I get Lung Cancer Genomic testing in India?

You can get your Lung Cancer Genomic testing done at 4baseCare, a leading precision oncology firm that offers the most advanced genomic solutions available in India.

4baseCare’s genetic testing portfolio represents dual focus: Accessibility and Affordability. It is curated such that every patient gets access to the most advanced genomic solutions, true to our purpose of providing cancer patients with the best chance at fighting cancer.

Cost of Lung Cancer Genomic testing in India

The cost of Lung Cancer Genomic testing depends on the number of biomarkers being tested and where you choose to get your test done. A single biomarker test such as EGFR test may cost around ₹5,000 to ₹25,000, while a more comprehensive mutation panel may cost around ₹10,000 to ₹25,000.

How do I book my Lung Cancer Genomic test in India?

Visit our website www.4basecare.com to book any DNA test. Alternatively, you can also write to us at info@4basecare.com and one of our qualified professionals will get back to you at the earliest.

Rest assured that our team of experts will support you and clarify all your queries related to genetic testing.

References

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  2. Watson, S. (2022, September 30). Lung cancer mutations: TP53, KRAS, EGFR, ALK, and more. Healthline. Retrieved January 9, 2023, from https://www.healthline.com/health/nsclc/guide-to-lung-cancer-mutations#types-of-mutations
  3. MediLexicon International. (n.d.). Lung cancer mutations: Types, causes, treatment, and more. Medical News Today. Retrieved January 9, 2023, from https://www.medicalnewstoday.com/articles/lung-cancer-mutations#treatment
  4. Watson, S. (2022, September 13). What you need to know about lung cancer biomarkers. Healthline. Retrieved January 9, 2023, from https://www.healthline.com/health/lung-cancer/lung-cancer-biomarkers#types
  5. 9, J. (2023, January 4). What to know about biomarker testing for lung cancer: An expert Q&A. Cancer.Net. Retrieved January 9, 2023, from https://www.cancer.net/blog/2022-06/what-know-about-biomarker-testing-lung-cancer-expert-qa
  6. Nath A;Sathishkumar K;Das P;Sudarshan KL;Mathur P; (n.d.). A clinicoepidemiological profile of lung cancers in India – results from the National Cancer Registry Programme. The Indian journal of medical research. Retrieved January 9, 2023, from https://pubmed.ncbi.nlm.nih.gov/35946203/
  7. Cancer screening testing lab India, BRCA, hereditary lung colon cancer. India’s Best NABL Accredited DNA Genetic, Screening, Routine Testing & Diagnostic Labs | Pathology. (n.d.). Retrieved January 9, 2023, from https://www.genes2me.com/service/oncology
  8. Trusted lung cancer test in India – EGFR test & kras testing. Positive Bioscience. (2020, April 21). Retrieved January 9, 2023, from https://positivebioscience.com/cancer-test-in-india/positiveselect/positive-bioscience-positiveselect-lung-lung-cancer-test/
  9. Explore full test menu. LalpathLabs. (n.d.). Retrieved January 9, 2023, from https://www.lalpathlabs.com/oncopro/lung-cancer.aspx
  10. Kiran, R. (2021, May 28). What is lung cancer mutation panel test ? DNA Labs India. Retrieved January 9, 2023, from https://dnalabsindia.com/test/lung-cancer-mutation-panel-test
  11. Get a genetic testing for cancer risk assessment. DNA Forensics. (2022, December 7). Retrieved January 9, 2023, from https://www.dnaforensics.in/product/genetic-testing-for-cancer/
  12. EGFR mutation test: Overview, price and result: Metropolis Healthcare. Metropolis India Lab. (n.d.). Retrieved January 9, 2023, from https://www.metropolisindia.com/parameter/egfr-mutation-analysis#:~:text=The%20cost%20of%20EGFR%20Mutation,%E2%82%B98000%20to%20%E2%82%B99900.
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