ASCO Endorses Molecular Testing Guideline Update for TKI Treatment in Lung Cancer
The American Society of Clinical Oncology (ASCO) has endorsed updated recommendations for molecular testing for selecting patients with lung cancer for treatment with targeted tyrosine kinase inhibitors (TKIs), as recently adopted by the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Co-chairs of the ASCO expert panel, Gregory P. Kalemkerian, MD, of the University of Michigan, Ann Arbor, and Navneet Narula, MD, of Weill Cornell Medical College, New York, and colleagues published the endorsement in the Journal of Clinical Oncology, calling the guideline “clear, thorough, and based upon the most relevant scientific evidence.”
Among the updated guideline’s key elements are:
- To test any sample with adequate cellularity and preservation. Analytic methods must be able to detect mutation in a sample with as few as 20% cancer cells.
- To not evaluate EGFRexpression by immunohistochemistry to select patients for EGFR-targeted therapy.
- To use stand-alone ROS1testing with additional confirmation testing in all patients with advanced lung adenocarcinoma. RET, ERBB2 (HER2), KRAS, and MET testing is recommended as part of larger panels.
- To use stand-alone BRAFtesting in patients with advanced lung adenocarcinoma.
The guideline also includes recommendations for testing methods for lung cancers that have a nonadenocarcinoma non–small-cell component, for patients with targetable mutations who have relapsed on targeted therapy, and for testing the presence of circulating cell-free DNA.