Updated Guidelines for Molecular Testing and Targeted Therapies in Lung Cancer
Three leading medical societies—the College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP)—have updated their 2013 evidence-based guideline for molecular testing and targeted therapies in lung cancer. “Updated Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment with Targeted Tyrosine Kinase Inhibitors” continues to set standards for the molecular analysis of lung cancers for test results that effectively guide targeted lung cancer therapy. The complete guideline is available online at the Journal of Thoracic Oncology.
The updated guideline strengthens or reaffirms the majority of the 2013 recommendations for patients with lung adenocarcinoma and also recommends testing for some new genes. Here is a sampling of the recommendations:
- Testing for ROS1 mutations is new and strongly recommended for all patients with lung cancer regardless of clinical characteristics.
- Multiplexed genetic sequencing panels (eg, next-generation sequencing testing) are preferred over multiple single-gene tests to identify other treatment options beyond EGFR, ALK, and ROS1. However, single-gene assays are still acceptable.
- When next-generation sequencing is performed, several other genes are also recommended: BRAF, ERBB2, MET, RET, and KRAS. However, these genes are not essential when only single-gene tests are performed.
- Testing in relapse is required for EGFR (T790M), but not for ALK, as the differential sensitivities of second-line ALK inhibitors in the setting of specific acquired mutations in ALK have not yet sufficiently matured and are still investigational.