Finding KRAS G12C starts with you

The advanced NSCLC landscape is evolving: Test for emerging biomarkers, like KRAS G12C mutations, at diagnosis

Consider KRAS G12C as part of your testing panel at diagnosis of advanced NSCLC

KRAS mutations evolution

KRAS mutations are commonly found in lung adenocarcinomas; therefore, testing at diagnosis is important2

 
KRAS testing recommendation

KRAS testing is recommended to be a part of an expanded panel at diagnosis by CAP/IASLC/AMP and ASCO guidelines3,4

DNA Sequence

KRAS is already included in many expanded panels;
consider highlighting KRAS G12C status3,5

It’s important to know your NSCLC patients’ biomarker status at diagnosis

KRAS mutations in NSCLC are associated with clinical heterogeneity6

KRAS NSCLC patient

While KRAS mutations are commonly found in current and former smokers, it is important to also test non-smokers2

KRAS G12C can be detected by various testing methods

Expanded panels can detect emerging biomarkers like KRAS G12C in addition to predictive biomarkers3

  Multigene panel (eg,
NGS, multiplex PCR) Multigene DNA Panel
Emerging biomarkers7,8 KRAS, MET, RET, ERBB2, and more
Actionable biomarkers9,10 EGFR, ALK, ROS1, BRAF, NTRK
Turnaround time8,11 2–3 days (Multiplex PCR)
7–20 days (NGS)

  • Single-gene tests may allow for a focused evaluation of specific biomarkers for different clinical scenarios3,8

Tissue or liquid biopsy can be used for KRAS G12C testing

For tissue biopsy, it is important to consider:

Pathologist tissue biopsy
Pathologist tissue biopsy sample Collection methods12
  
Pathologist tissue biopsy sample Adequate sample quantity and quality12
  
Pathologist tissue biopsy sample Sample DNA integrity13

 

Liquid biopsy can be a minimally invasive option, and it is important to consider13:

Pathologist liquid biopsy
Pathologist liquid biopsy needle Tissue biopsy may not be feasible for 10% to 20% of patients with advanced NSCLC14,15
   
Pathologist liquid biopsy needle Liquid biopsy may overcome the challenges of capturing tumor heterogeneity and sampling bias8,13
   
Pathologist liquid biopsy needle A comprehensive analysis has shown that liquid biopsy tests could be > 90% concordant with tissue across multiple biomarkers tested16
   
Pathologist liquid biopsy needle Assay sensitivity and specificity should be considered when choosing liquid biopsy3,8
Liquid Testing Lab Liquid Testing Lab

CAP/IASLC/AMP recommends use of liquid biopsy as an option to test when sufficient tissue is not available3

Preparing for KRAS G12C testing

Biomarker testing is recommended for newly diagnosed advanced NSCLC patients3,17

Oncologist and Pathologist Team

 

Consider:

Checking Resources Including KRAS G12C on medical records, LIMS, lab results portals, and test requisition forms
  
Collecting adequate tissue
  
DNA Communicating the importance of testing at diagnosis of advanced NSCLC disease
  
Selecting Appropriate Testing Methods Selecting appropriate testing methods that ensure a timely turnaround of results
  
Reporting Clearly reporting and highlighting KRAS G12C status at diagnosis
  
Multidisciplinary team Sharing results with multidisciplinary team
  
Oncologist Providing the oncologist testing options, such as tissue or liquid at progression
Sequencing Sequencing

Finding The Unseen 13% starts with you

Have more questions on KRAS G12C testing?

Mobile Contact Amgen Medical Information

 

ALK, anaplastic lymphoma kinase; AMP, Association for Molecular Pathology; ASCO, American Society of Clinical Oncology; BRAF, v-Raf murine sarcoma viral oncogene homolog B; CAP, College of Clinical Pathologists; EGFR, epidermal growth factor receptor; ERRB2, v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 2; IASLC, International Association for the Study of Lung Cancer; KRAS, Kirsten rat sarcoma; LIMS, laboratory information management system; MET, mesenchymal epithelial transition; NSCLC, non–small cell lung cancer; NGS, next-generation sequencing; NTRK, neurotrophic-tropomyosin receptor kinase; PCR, polymerase chain reaction; RET, rearranged during transfection; ROS1, ROS proto-oncogene 1, receptor tyrosine kinase.

References: 1. Biernacka A, Tsongalis PD, Peterson JD, et al. Cancer Genet. 2016;209(5):195-198. 2. Roman M, Baraibar I, Lopez I, et al. Mol Cancer. 2018;17(1):33. 3. Lindeman NI, Cagle PT, Aisner DL, et al. Arch Pathol Lab Med. 2018;142(3):321-346. 4. Kalemkerian GP, Narula N, Kennedy EB, et al. J Clin Oncol. 2018;36(9):911-919. 5. FoundationOne CDx [Package Insert]. Cambridge, MA: Foundation Medicine, Inc.; 2017. 6. Skoulidis F, Heymach JV. Nat Rev Cancer. 2019;19(9):495-509. 7. Nagasaka M, Li Y, Sukari A, et al. Cancer Treat Rev. 2020;84:101974. 8. Pennell N, Arcila M, Gandara D, et al. Am Soc Clin Oncol Educ Book. 2019;39:531-542. 9. Yoda S, Dagogo-Jack I, Hata AN. Pharmacol Ther. 2019;193:20-30. 10. Zhang C, Leighl NB, Wu YL, et al. J Hematol Oncol. 2019;12(1):45. 11. Vnencak-Jones C, Berger M, Pao W. My Cancer Genome. 2016. https://www.mycancergenome.org/
content/molecular-medicine/types-of-molecular-tumor-testing/ (Updated February 8). 12. Kim L, Tsao MS. Eur Respir J. 2014;44(4):1011-1022. 13. Diaz LA Jr, Bardelli A. J Clin Oncol. 2014;32(6):579-586. 14. Wu Z, Yang Z, Dai Y, et al. Onco Targets Ther. 2019;12:5097‐5109 15. Lim C, Sung M, Shepherd E, et al. J Thorac Oncol. 2016;11(1):79-84. 16. Leighl N, Page R, Raymond V, et al. Clin Cancer Res. 2019;25(15):4691-4700. 17. Kim ES, Basu Roy U, Ersek JL, et al. J Thorac Oncol. 2019;14(3):338-342.