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

It may be difficult to know which questions to ask and when in terms of biomarker testing-sometimes called genetic, genomic or molecular testing. Comprehensive biomarker testing is an important part of your treatment journey. 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:

• Ask them to take enough tissue out during the biopsy for next-generation sequencing (a type of test that can look for a large number of alterations in the tumor).

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 it has not been tested, ask why. Some common reasons include
  • Not enough tissue was able to be removed safely
  • 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 may provide some results why you wait for the NGS testing to come back. It may also provide information if your doctor was unable to do a tissue biopsy.
• Confirm your doctor intends to test your tumor’s PD-L1 levels which provides information about how you may respond to immunotherapy.
• Ask your doctor if it is possible to not start on 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 of the relevant biomarkers for lung cancer. Ask how the test results influence your treatment options.
• Ask your doctor about the goal of the treatment and what you can expect in terms of side effects and how well the treatment will work. Tell your doctor what is 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.
• Connect with support networks like the Lung Cancer Survivors Community on Inspire or request a mentor.

When it is time to change your treatment:

• Eventually, your cancer may start to grow on your current treatment, and you will need to change your treatment. Ask your doctor if you need a liquid biopsy (a blood test) or tissue biopsy to inform your next treatment decision.
• Ask your doctor to review all new test results and the pros and cons of your treatment options.

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