Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment With Targeted Tyrosine Kinase Inhibitors-Guia Atualizado de Testes Moleculares Para a Seleção de Pacientes Com Câncer de Pulmão Para Tratamento com Inibidores Alvo de Tirosina Quinase

Guia Atualizado de Testes Moleculares Para a Seleção de Pacientes Com Câncer de Pulmão Para Tratamento com Inibidores Alvo de Tirosina Quinase

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The updated guidelines for molecular testing in lung cancer patients include recommendations for testing additional genes such as ROS1, BRAF, RET, ERBB2, and MET. The guidelines emphasize the use of immunohistochemistry (IHC) and next-generation sequencing (NGS) panels for testing. They recommend against using IHC for EGFR testing and using total protein expression of EGFR for EGFR targeted therapy. Cytology samples are deemed acceptable for testing, and laboratories should be able to detect mutations in samples with at least 20% tumor content. The guidelines also address testing in non-adenocarcinoma lung cancers and provide recommendations for testing in patients with resistance to targeted therapies. The use of circulating cell-free DNA (cfDNA) testing is discussed, stating that it can be used in certain clinical situations when tissue samples are limited. Overall, the updated guidelines provide comprehensive recommendations for molecular testing in lung cancer patients.<br /><br />In 2018, the minimum recommendation for molecular testing in lung cancer patients is to test for EGFR, ALK, and ROS1 genes. Additional genes such as BRAF, MET, RET, ERBB2, and KRAS should be included in expanded panels if adequate material is available. IHC is now considered an equivalent alternative to FISH for ALK testing, with similar sensitivity and specificity. Other genes such as RET, ERBB2, and BRAF should be included in comprehensive panels but are not recommended for routine independent testing. The choice of testing method and genes to include in panels should be based on available evidence and ongoing research in the field. New biomarkers such as NTRK and FGFR may be included in testing in the future.<br /><br />The new guideline for molecular testing in lung cancer highlights the importance of accurately identifying specific genetic mutations to determine appropriate treatment options. It emphasizes comprehensive testing for common mutations such as EGFR, ALK, ROS1, and BRAF. The guideline also discusses the potential use of liquid biopsy testing when tissue is limited. Immunotherapy and testing for PD-L1 expression in patients being considered for immunotherapy are also addressed. The goal of the guideline is to provide clear recommendations for molecular testing in lung cancer patients to identify the most appropriate treatments based on individual genetic profiles.

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Keywords

molecular testing

lung cancer patients

ROS1

BRAF

RET

ERBB2

MET

immunohistochemistry

next-generation sequencing

EGFR testing