Lung cancer specialized testing in NSCLC: What do we do if we biopsy a suspected metastatic lesion?* Immunohistochemistry (IHC): **Confirm if it is metastatic NSCLC **Confirms the histology of the NSCLC (such as adenocarcinoma vs. squamous cell)**Used to determine the type of chemotherapy that can be administered for treatment *PDL1 testing: **PDL1 is a protein expressed by certain cancer cells allowing them to evade the immune system (“fake mustache analogy”).**Also confirmed by IHC**This protein is targetable!**Often measured as:***Total protein expression (TPS): The number of positive tumor cells divided by the total number of viable tumor cells multiplied by 100%***Composite protein expression (CPS): The number of positive tumor cells, lymphocytes and macrophages, divided by the total number of viable tumor cells multiplied by 100%*Molecular testing: **We discuss this in detail in Episode 005**Genetic information from the tissue sample**Always better to get sample from soft tissue than from bone**Why is this important?***To be able to identify “driver mutations”****What is it? Important mutations that may be “driving” oncogenesis****Many of these have drugs that directly target these mutationsPrognostic vs. predictive biomarkers:*Prognostic biomarkers: Mutations or changes that give information about the cancer’s overall outcome regardless of therapy*Predictive biomarkers: Mutations that provide information about how a cancer may respond to a particular drug Cell-free DNA (AKA “liquid biopsy”):*Special tests that can detect microscopic amounts of cancer cell DNA within the patient’s blood which may also be used to find prognostic/predictive biomarkers*Ongoing studies to see if this can be used to find relapse of diseasePlease visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast