Episode 61: The Crucial Role of Biomarkers in Decoding Lung Cancer with Kimary Kulig, PhD, MPH
In this episode, Kimary Kulig, PhD, MPH dives into the topic of cancer biomarkers. Kimary explains the difference between genes and proteins, germline versus somatic gene testing, and the critical importance of testing for both as biomarkers for treatment selection. She also describes the world of lung cancer biomarkers and the implications for treatment decisions. The conversation highlights the need for patients and their families to understand biomarkers and the impact those biomarkers have on treatment options. Biomarker testing in cancer patients is crucial for personalized treatment, but there are significant challenges and delays in the current system. The long turnaround time for biomarker testing can be harmful to patients with aggressive cancers who need immediate, targeted treatment. This delay often leads to patients starting chemotherapy while waiting for test results, which can impact the effectiveness of targeted therapies. The current system also lacks “reflex” testing, where biomarker testing is automatically ordered based on the type of cancer. Kimary highlights that patients and their families need to be aware of the importance of biomarker testing and advocate for it.
Key Highlights:
- Biomarker testing should encompass both germline and somatic gene alterations. Germline testing is sometimes called “genetic testing” and identifies inherited mutations that appear in every cell in the body, whereas somatic gene testing detects mutations just in cancer cells, some of which can be targeted with specific drugs.
- There can be significant delays in biomarker testing results, which can be particularly harmful for patients with aggressive cancers. These delays often result in patients beginning chemotherapy while awaiting results, potentially impacting the efficacy of targeted therapies.
- Kimary discusses the lack of “reflex” testing in the current system, where biomarker tests are not automatically ordered based on the type of cancer. Implementing reflex testing could speed up the process, ensuring timely and appropriate treatment for patients.
About our guest:
Kimary Kulig’s professional career has spanned the academic, non-profit, large pharma, start-up, and healthcare technology ecosystems. Kimary is currently Owner and Principal of Kulig Consulting, providing advice and service to biotech start-up, pharmaceutical, and medical device companies who develop oncology products. She also provides individual Biomarker Navigation services to cancer patients as My Biomarker Navigator™. Kimary applied her unique training in immunology, molecular oncology, and epidemiology for 12 years at both Pfizer and Bristol Myers Squibb. Her pharma career is highlighted by research on lung cancer biomarkers which are now standard of care companion diagnostics. Kimary was also Vice President at the National Comprehensive Cancer Network (NCCN) where she oversaw all operations of its Outcomes Research Database. At Verily Life Sciences, Kimary was Head of Oncology Clinical Research and led digital pathology machine learning and wearable device oncology application development. Kimary continues in her goal to bring AI tools to clinical practice as a member of the Friends of Cancer Research Digital Pathology Working Group. Kimary received her PhD from New York University’s Institute of Graduate Biomedical Sciences and her MPH from Columbia University’s Mailman School of Public Health.
Key Moments:
6 minutes: “Genetic testing, as it's called in the clinic, is really looking at germline alterations in DNA. And what does that mean? Germline refers to the origin of the DNA being from germ cells. You get egg from mom, sperm from dad. Those are germ cell lineages. And so when we talk about genetic testing or germline mutation testing, we're really looking at what is an inherited gene alteration, a mutation for example, that you got from your parents and it's in all of your DNA, in all of your cells, in your entire body. It's not just in your tumor. When we talk about somatic mutation testing, we're looking at something that is in the tumor and not necessarily in your germline. It's not in the germline actually. So when you have tumor biomarker testing, you're looking at somatic mutations mostly, but some of those somatic mutations could actually be germline mutations. So you may have inherited them.”
18 minutes: “I say lung cancer is currently the king of biomarkers. There are more validated biomarkers in lung cancer right now than any other solid tumor type. I think breast maybe comes in second, but right now there are 12 different biomarkers per NCCN guidelines that should be, that every patient with non-small cell lung cancer, particularly adenocarcinoma, should be tested for. And yet we know that 100 % of them are not being tested for that, but that's another story.”
47 minutes: “ I think the first thing is just to be aware of [biomarker testing] as critical, and it's a part of your care that can't be skipped. The first question I always ask a patient is, have you had biomarker testing? And oftentimes the answer is, I don't know, or they don't know how to find it. And part of the problem is it's not often uploaded into your MyChart or your patient portal.So that's the first thing I coach them is, it's something you have to ask for.”
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YouTube Tags: cancer biomarkers, genes, proteins, genetic testing, biomarker testing, germline testing, lung cancer, treatment decisions, biomarker testing, cancer, personalized treatment, delays, turnaround time, chemotherapy, targeted therapy, reflex testing, pathologist, patient advocacy