Detecting HER2 (ERBB2) mutations in patients with mNSCLC

Broad molecular profiling with NGS is recommended by clinical guidelines to comprehensively identify genetic biomarkers in mNSCLC—including HER2 (ERBB2) mutations1,2

Lung shaped claw holding the HER2 mutation
Both tissue and blood are recommended sample types for NGS

Tissue sample3-6

  • Preferred sample type for NGS
  • Numerous methods are available for acquiring tumor samples, including biopsy and surgery
  • Collecting enough tissue at diagnosis is important, since the sample quantity and quality will affect both histologic characterization and biomarker testing
  • Tissue-based NGS is well established and commonly used at diagnosis when tissue is collected as part of routine workup

Blood sample3,6,7

  • Acquired through venipuncture with appropriate sample handling requirements
  • Particularly relevant when tumor tissue is insufficient, unavailable, or a significant delay is expected in obtaining tumor tissue
  • Captures tumor heterogeneity
  • Negative results require confirmation with tissue-based testing due to reliance on tumor shedding
  • Turnaround times for blood-based NGS are typically faster than tissue-based testing
ERBB2, erb-b2 receptor tyrosine kinase 2; HER2, human epidermal growth factor receptor 2; mNSCLC, metastatic non-small cell lung cancer; NGS, next-generation sequencing.

Complementary tissue and blood-based sample types can be used for NGS to identify biomarkers at different points along the continuum of care for patients with mNSCLC6,8

Widespread NGS and multidisciplinary team collaboration can help ensure that emerging biomarkers such as HER2 (ERBB2) mutations are identified, reported, and captured in a patient's clinical profile1,2,4,5,9

  • If NGS was previously performed, looking back at the initial report could identify patients with a HER2 mutation
BROAD MOLECULAR PROFILING WITH NGS ENSURES THAT HER2 (ERBB2) MUTATION STATUS IS CAPTURED FOR EVERY PATIENT WITH mNSCLC1,2,4,9

Consistent reporting of HER2 (ERBB2) mutation status is critical

Reporting of HER2 (ERBB2) mutation status should be uniform, contain consistent nomenclature, and include key information required to inform clinical decisions1,9

  • NGS reports should show HER2 (ERBB2) mutation alongside driver mutations and actionable biomarkers
  • NGS reports should be properly annotated in the Electronic Health Record (EHR) system
  • If reports are from an external lab, HER2 (ERBB2) mutation status should be noted or highlighted in the list of other clinically relevant biomarkers for patients with mNSCLC
REPORT HER2 (ERBB2) MUTATIONS ALONG WITH OTHER BIOMARKERS IN mNSCLC TO HELP INFORM CLINICAL DECISIONS1,9
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References: 1. Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med. 2018;142(3):321-346. doi:10.5858/arpa.2017-0388-CP 2. Planchard D, Popat S, Kerr K, et al. ESMO Guidelines Committee; Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(suppl 4):iv192-iv237 3. Ilié M, Hofman P. Pros: can tissue biopsy be replaced by liquid biopsy? Transl Lung Cancer Res. 2016;5(4):420-423. doi:10.21037/tlcr.2016.08.06 4. Conterato AJ, Belanger AR, Yarmus LB, Akulian JA. Update on NSCLC tissue acquisition, processing, and profiling in the molecular age. Hematol Med Oncol. 2017;2(2):1-8. doi:10.15761/HMO.1000121 5. Ofiara LM, Navasakulpong A, Beaudoin S, Gonzalez AV. Optimizing tissue sampling for the diagnosis, subtyping, and molecular analysis of lung cancer. Front Oncol. 2014;4:253. doi:10.3389/fonc.2014.00253 6. Rolfo C, Mack PC, Scagliotti GV, et al. Liquid biopsy for advanced non-small cell lung cancer (NSCLC): a statement paper from the IASLC. J Thorac Oncol. 2018;13(9):1248-1268. doi:10.1016/j.jtho.2018.05.030 7. Ialongo C, Bernardini S. Phlebotomy, a bridge between laboratory and patient. Biochem Med (Zagreb). 2016;26(1):17-33. doi:10.11613/BM.2016.002 8. Aggarwal C, Thompson JC, Black TA, et al. Clinical implications of plasma-based genotyping with the delivery of personalized therapy in metastatic non–small cell lung cancer. JAMA Oncol. 2019;5(2):173-180. doi:10.1001/jamaoncol.2018.4305 9. Li MM, Datto M, Duncavage EJ, et al. Standards and guidelines for the interpretation and reporting of sequence variants in cancer: a joint consensus recommendation of the Association for Molecular Pathology, American Society of Clinical Oncology, and College of American Pathologists. J Mol Diagn. 2017;19(1):4-23. doi:10.1016/j.jmoldx.2016.10.002