Clinical perspectives on serum tumor marker use in predicting prognosis and treatment response in advanced non-small cell lung cancer

Abstract

The optimal positioning and usage of serum tumor markers (STMs) in advanced non-small cell lung cancer (NSCLC) care is still unclear. This review aimed to provide an overview of the potential use and value of STMs in routine advanced NSCLC care for the prediction of prognosis and treatment response. Radiological imaging and clinical symptoms have shown not to capture a patient’s entire disease status in daily clinical practice. Since STM measurements allow for a rapid, minimally invasive, and safe evaluation of the patient’s tumor status in real time, STMs can be used as companion decision-making support tools before start and during treatment. To overcome the limited sensitivity and specificity associated with the use of STMs, tests should only be applied in specific subgroups of patients and different test characteristics should be defined per clinical context in order to answer different clinical questions. The same approach can similarly be relevant when developing clinical applications for other (circulating) biomarkers. Future research should focus on the approaches described in this review to achieve STM test implementation in advanced NSCLC care.

Lung cancer tumor marker analysis: A clinical laboratory perspective

“…For instance, certain lung cancer tumor markers, like neuron-specific enolase (NSE) and progastrin-related peptide (ProGRP), might be more relevant for follow-up of small cell lung cancer (SCLC), while others, such as carcinoembryonic antigen (CEA), cytokeratin-19 fragments (CYFRA 21-1) and squamous cancer cell antigen (SCCA), are more relevant for non-small cell lung cancer (NSCLC) [2,3]. In addition, the clinical setting is crucial, as most tumor markers currently have limited value for lung cancer screening but can be highly relevant for monitoring of systemic treatment in advanced lung cancer [4]. Also the timing of tumor marker testing is important and must be aligned with key clinical decision moments and provide relevant additional clinical information for the specific clinical context.…”

Lung cancer biomarkers: Raising the clinical value of the classical and the new ones

“…Geiger et al [36] have conducted a biomarker substudy of the CEPAC-TDM trial, testing eight tumor markers before and during chemotherapy for their relevance in prognosis and predicting therapy response in advanced NSCLC patients. Finally, Buma et al [37] review the utility of serum tumor markers in predicting prognosis and treatment response in advanced NSCLC.…”

Integrating treatment cost reduction strategies and biomarker research to reduce costs and personalize expensive treatments: an example of a self-funding trial in non-small cell lung cancer

“…Therefore, the DEDICATION-1 trial has been designed to serve as a platform for extensive biomarker research that investigates multiple biomarkers (e.g., liquid biopsies, proteomics, pharmacokinetics and immunopharmacology, exhaled breath, artificial intelligence (AI)-based lung imaging, computational pathology, and the microbiome) in order to assess their utility–both individually and within the context of a compound biomarker–in predicting (non-)response to pembrolizumab-containing treatment. Importantly, the trial design allows for the development of predictive biomarkers that are able to identify both primary treatment resistance (e.g., predictive biomarkers that predict (non-)response before start or early after start of treatment) and secondary treatment resistance (e.g., monitoring biomarkers that can be applied to identify (non-)response during course of treatment) ( Buma et al, 2021 ; van Delft et al, 2022 ; Buma et al, 2023 ). In parallel, an early Health Technology Assessment (HTA) analysis is being performed to assess the value of biomarker-guided treatment selection by providing high-quality research information on the effectiveness, costs, and impact of the implementation of such an approach ( Ferraro et al, 2022 ).…”