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With aggressive disease and low survival, choosing the best treatment is critical.

NexCourse for non-small cell lung cancer (NSCLC) provides actionable results in a concise, patient-specific, summary report with clinically relevant information to assist treatment decisions.

Select from our suite of molecular tests to receive the necessary information for a treatment course of action. When two or more molecular tests are ordered, you will receive a concise summary of results.

NexCourse NSCLC helps you:

  • Determine treatments to which each patient is more likely to respond favorably
  • Detect which therapies are more likely to cause severe toxic side effects
  • Assess predictive and prognostic molecular markers for many first- and second-line NSCLC treatments1-3

Molecular Testing Helps to Predict Patient Response

Molecular markers included in NexCourse NSCLC can help predict whether or not a patient is likely to respond to certain treatments, and which may be ineffective or toxic. This can help guide treatment decisions, which may improve patient care.


 Predictive Predictive and Prognostic
  UGT1A1 EGFR Amp EGFR Mut ERCC1 RRM1 TS
Carboplatin          
Cisplatin          
Cetuximab          
Erlotinib        
Gemcitabine          
Irinotecan          
Pemetrexed          

CARBOPLATIN AND CISPLATIN4-7

ERCC1 predicts the likelihood of response to platinum-based therapy

  • High levels of ERCC1 are associated with relative resistance, while low levels are associated with relative sensitivity.
  • In the absence of therapy, high levels are suggestive of better overall survival probability for patients with NSCLC.

CETUXIMAB AND ERLOTINIB8-11

EGFR mutation and EGFR amplification help predict the likelihood of response to EGFR inhibitors

  • EGFR amplification in tumors, high polysomy or gene copy number, is associated with better treatment response to EGFR inhibitors.
  • Mutations in the EGFR gene are a positive predictor of effectiveness of tyrosine kinase inhibitors (TKIs) such as erlotinib.
  • Mutations in the EGFR are prognostic with or without chemotherapy.

GEMCITABINE7,12,13

Ribonucleotide reductase M1 (RRM1) predicts the likelihood of response to gemcitabine-based therapy

  • High expression of RRM1 in tumor tissue is predictive of poor response to gemcitabine treatment.
  • In the absence of therapy, high levels are suggestive of better overall survival probability for patients with NSCLC.

IRINOTECAN14-15

UGT1A1 is involved in irinotecan metabolism and toxicity tolerance

  • UGT1A1 gene mutation is associated with decreased ability to metabolize irinotecan, resulting in potential for severe toxicity.

PEMETREXED16,17

Thymidylate synthase (TS) gene expression predicts likelihood of response to pemetrexed

  • Low levels of TS gene expression may be associated with better treatment response in NSCLC.

  1. NCCN Clinical Practice Guidelines in Oncology, Non-Small Cell Lung Cancer V.2.2010.
  2. Pisters KM, Evans WK, Azzoli CG, et al. Cancer Care Ontario and American Society of Clinical Oncology adjuvant chemotherapy and adjuvant radiation therapy for stages I-IIIA resectable non-small cell lung cancer guideline. J Clin Oncol. 2007;25(34):5506-5518.
  3. Azzoli CG. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small cell lung cancer. J Clin Oncol. 2010;6(1):39-43.
  4. Olaussen K, Dunant A, Fouret P, et al. DNA repair by ERCC1 in non-small cell lung cancer and cisplatin-based adjuvant chemotherapy. N Engl J Med. 2006;355:983-991.
  5. Cobo M. Customizing cisplatin based on quantitative excision repair cross-complementing 1 mRNA expression: a phase III trial in non-small cell lung cancer. J Clin Oncol. 2007;25(19):2747-2754.
  6. Lord RV, Brabender J, Gandara D, et al. Low ERCC1 expression correlates with prolonged survival after cisplatin plus gemcitabine chemotherapy in non-small cell lung cancer. Clin Cancer Res. 2002;8(7):2286-2291.
  7. Ceppi P, Volante M, Novello S, et al. ERCC1 and RRM1 gene expressions but not EGFR are predictive of shorter survival in advanced non-small cell lung cancer treated with cisplatin and gemcitabine. Ann Oncol. 2006;17(12):1818-1825.
  8. Slebos RJ, Kibbelaar RE, Dalesio O, et al. K-ras oncogene activation as a prognostic marker in adenocarcinoma of the lung. N Eng J Med. 1990;323(9):561-565.
  9. Zhu CQ, da Cunha Santos G, Ding K, et al. Role of KRAS and EGFR as biomarkers of response to erlotinib in National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol. 2008;26(26):4268-4275.
  10. Tsao MS, Sakurada A, Cutz JC, et al. Erlotinib in lung cancer—molecular and clinical predictors of outcome. N Eng J Med. 2005;353(2):133-144.
  11. Eberhard DA, Johnson BE, Amler LC, et al. Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol. 2005;(23)25:5900-5909.
  12. Bepler G, Kusmartseva I, Sharma S, et al. RRM1 modulated in vitro and in vivo efficacy of gemcitabine and platinum in non-small cell lung cancer. J Clin Oncol. 2006;24(29):4731-4737.
  13. Rosell R, Danenberg KD, Alberola V, et al. Ribonucleotide reductase messenger RNA expression and survival in gemcitabine/cisplatin-treated advanced non-small cell lung cancer patients. Clin Cancer Res. 2004;10(4):1318-1325.
  14. Hoskins JM, Goldberg RM, Qu P, et al. UGT1A1*28 genotype and irinotecan-induced neutropenia: dose matters. J Natl Cancer Inst. 2007;99(17):1290-1295.
  15. Rouits E, Charasson V, Petain A, et al. Pharmacokinetic and pharmagenetic determinants of the activity and toxicity of irinotecan in metastatic colorectal cancer. Br J Cancer. 2008;99(8):1239-1245.
  16. Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naïve patients with advanced-stage non-small cell lung cancer. J Clin Oncol. 2008;26(21):3543-3551.
  17. Ceppi P, Volante M, Saviozzi S, et al: Squamous cell carcinoma of the lung compared with other histotypes shows higher messenger RNA and protein levels for thymidylate synthase. Cancer. 2006;107(7):1589-1596.


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