Updated Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment with Targeted Tyrosine Kinase Inhibitors, Key Messages-Key Messages

Key Messages

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The College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP) have released an updated guideline for molecular testing in lung cancer patients. The guideline aims to provide evidence-based standards for clinical molecular testing of non-small cell lung cancers (NSCLC) to guide targeted therapy and treatment. The revision is necessary due to rapid advancements in understanding lung cancer and the growth of available targeted therapies. The updated guideline recommends testing for new genes, including ROS1 mutations, which is now strongly recommended for all lung cancer patients. Multiplexed genetic sequencing panels, such as NGS, are preferred over single-gene tests to identify treatment options beyond EGFR, ALK, and ROS1. The guideline also recommends testing for additional genes such as BRAF, ERBB2, MET, RET, and KRAS when NGS is performed. Testing for EGFR T790M in relapse is required, but testing for ALK mutations in relapse is still investigational. It is recommended to perform biopsies or use cell-free circulating DNA for testing in relapse. The guideline also reinforces previous recommendations regarding ALK testing, appropriate samples for testing, and the inclusion of IHC for ALK as an alternative to FISH. The guideline also addresses molecular testing for lung cancers without an adenocarcinoma component. The guideline was developed by an international panel of experts and underwent extensive literature review, open comment periods, and scientific peer review. Implementation of the guideline is encouraged to improve patient outcomes. The organizations involved in the development of this guideline aim to continually educate stakeholders and advance the quality of diagnostic medicine in lung cancer. As technology and understanding of lung cancer continue to evolve, updates to the guideline are anticipated in the future.

Keywords

molecular testing

lung cancer patients

targeted therapy

ROS1 mutations

genetic sequencing panels

EGFR

ALK

BRAF

biopsies

patient outcomes