Can VeriStrat Predict Best Second-line Therapy in NSCLC?
Can VeriStrat Predict Best Second-line Therapy in NSCLC?
Stinchcombe TE, Roder J, Peterman AH, et al
J Thorac Oncol 2013;8:443-451
VeriStrat is a commercially available serum- or plasma-based test designed to identify which patients with advanced non-small cell lung cancer (NSCLC) are likely to receive clinical benefit from an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) such as erlotinib or gefitinib. The test evaluates pretreatment serum using matrix-assisted laser desorption ionization mass spectrometry to classify a patient as having a good or poor profile for treatment benefit.
Retrospective studies of validation cohorts in studies of EGFR TKI therapy vs placebo have confirmed that VeriStrat Good and Veristrat Poor profiles are associated with significant differences in outcomes of patients receiving an EGFR TKI.These outcomes are distinct from presence or absence of an EGFR or KRAS mutation, as well as an EGFR gene copy number. The VeriStrat profile is correlated with clinical parameters such as performance status but remains an independent predictive variable in multivariate analysis.
Despite the potential utility of this test, its use has remained rather limited. In my experience with it, patients with a VeriStrat Good profile tended to have a prolonged survival after receiving an EGFR TKI, yet several of them developed early progression and still did well. This suggests that the VeriStrat test may be more valuable in identifying patients who are likely to do well, independent of treatment, than as a tool to predict patients who are likely to benefit from a specific treatment. Moreover, many of my patients with advanced lung cancer who are eager for subsequent therapy are not especially interested in a test that potentially discounts the utility of a commercially available and approved agent for second- or third-line treatment without identifying a more favorable alternative.
A Retrospective Analysis of VeriStrat Status on Outcome of a Randomized Phase II Trial of First-line Therapy With Gemcitabine, Erlotinib, or the Combination in Elderly Patients (Age 70 or Older) With Stage IIIB/IV Non-small-cell Lung Cancer
Stinchcombe TE, Roder J, Peterman AH, et al
J Thorac Oncol 2013;8:443-451
Background
VeriStrat is a commercially available serum- or plasma-based test designed to identify which patients with advanced non-small cell lung cancer (NSCLC) are likely to receive clinical benefit from an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) such as erlotinib or gefitinib. The test evaluates pretreatment serum using matrix-assisted laser desorption ionization mass spectrometry to classify a patient as having a good or poor profile for treatment benefit.
Retrospective studies of validation cohorts in studies of EGFR TKI therapy vs placebo have confirmed that VeriStrat Good and Veristrat Poor profiles are associated with significant differences in outcomes of patients receiving an EGFR TKI.These outcomes are distinct from presence or absence of an EGFR or KRAS mutation, as well as an EGFR gene copy number. The VeriStrat profile is correlated with clinical parameters such as performance status but remains an independent predictive variable in multivariate analysis.
Despite the potential utility of this test, its use has remained rather limited. In my experience with it, patients with a VeriStrat Good profile tended to have a prolonged survival after receiving an EGFR TKI, yet several of them developed early progression and still did well. This suggests that the VeriStrat test may be more valuable in identifying patients who are likely to do well, independent of treatment, than as a tool to predict patients who are likely to benefit from a specific treatment. Moreover, many of my patients with advanced lung cancer who are eager for subsequent therapy are not especially interested in a test that potentially discounts the utility of a commercially available and approved agent for second- or third-line treatment without identifying a more favorable alternative.
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