Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment With Targeted Tyrosine Kinase Inhibitors-Updated Molecular Testing Guideline

Updated Molecular Testing Guideline - Summary of Recommedations

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A new guideline for molecular testing in lung cancer patients has been released by the College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP). The guideline provides recommendations on which genes should be tested in lung cancer patients and what methods should be used for testing.<br /><br />The guideline states that all lung adenocarcinoma patients should be tested for the ROS1 gene, regardless of clinical characteristics. It suggests that immunohistochemistry (IHC) can be used as a screening test for ROS1, but positive results should be confirmed by a molecular or cytogenetic method. BRAF, RET, ERBB2 (HER2), KRAS, and MET testing are not indicated as routine stand-alone assays, but can be included as part of larger testing panels if EGFR, ALK, and ROS1 testing are negative.<br /><br />For molecular testing, the guideline recommends that IHC is an equivalent alternative to fluorescence in situ hybridization (FISH) for ALK testing. It also recommends the use of multiplexed genetic sequencing panels over multiple single-gene tests to identify other treatment options. The guideline suggests that test results that are unexpected, discordant, or of low confidence should be confirmed or resolved using an alternative method or sample.<br /><br />The guideline also addresses the use of molecular testing in lung cancers that do not have an adenocarcinoma component, as well as testing for patients who have relapsed on targeted therapy. It provides recommendations on the use of circulating cell-free DNA (cfDNA) for diagnosis and mutation identification in lung cancer patients.<br /><br />Overall, the guideline provides updated recommendations on molecular testing in lung cancer patients, helping clinicians select appropriate targeted tyrosine kinase inhibitor (TKI) therapy based on the genetic profile of the tumor.

Keywords

molecular testing

lung cancer

guideline

ROS1 gene

immunohistochemistry

ALK testing

multiplexed genetic sequencing panels

circulating cell-free DNA

diagnosis

tyrosine kinase inhibitor