Selective Molecular Testing Recommended for Lung Cancer Patients

By Will Boggs MD

NEW YORK (Reuters Well being) – The American Society of Scientific Oncology (ASCO) has endorsed, with minor modifications, different skilled societies’ molecular pointers on deciding on sufferers with lung most cancers for remedy with focused tyrosine kinase inhibitors (TKIs). These pointers come from the Faculty of American Pathologists (CAP), the Worldwide Affiliation for the Examine of Lung Most cancers (IASLC), and the Affiliation for Molecular Pathology (AMP).

“All sufferers with superior lung adenocarcinoma ought to bear applicable molecular diagnostic testing that ought to embrace, at a minimal, analysis for driver mutations in EGFR, ALK, ROS1, and BRAF,” Dr. Gregory P. Kalemkerian from the College of Michigan, Ann Arbor, advised Reuters Well being by electronic mail.

Therapy with focused TKI remedy can enhance outcomes for sufferers with sure molecular alterations that may be recognized by molecular testing, prompting CAP/IASLC/AMP to subject practically two dozen suggestions that information molecular testing in figuring out these sufferers.

Dr. Kalemkerian and colleagues on the ASCO Knowledgeable Panel critically appraised and endorsed the up to date CAP/IASLC/AMP pointers of their February 5 Journal of Scientific Oncology on-line report.

“Broader multiplexed molecular diagnostic panels are preferred over single-gene testing if they are available,” Dr. Kalemkerian mentioned. “These may detect other driver mutations which may suggest alternative treatment options (MET, RET, HER2) or allow enrollment (in) clinical trials.”

Whereas supporting nearly all the up to date suggestions, ASCO suggests some modifications and qualifying statements.

ASCO doesn’t endorse the CAP/IASLC/AMP advice associated to BRAF testing in sufferers with superior adenocarcinoma. Because the up to date suggestions have been issued, FDA has granted approval for stand-alone BRAF testing; subsequently, the ASCO panel included this reality into their suggestions and suggest BRAF testing for all sufferers with superior lung adenocarcinoma.

The knowledgeable panel additionally notes that “the interpretation and implementation of some of the statements may be influenced by the geographic location and the practice setting (academic versus community). This may particularly be true for the statements that lack robust evidence and are either primarily consensus opinions or for statements that have no recommendation for or against a particular issue.”

The report particulars the 5 suggestions from 2013 that have been reaffirmed or up to date for 2017 and the 18 new 2017 suggestions, together with advised modifications and qualifying statements, in its “Bottom Line” desk.

“Open questions remain about the utility of molecular testing beyond EGFR, ALK, ROS1, and BRAF,” Dr. Kalemkerian mentioned. “These four biomarkers have FDA-approved targeted therapy associated with them, so they are not controversial. Beyond that, there is some clinical evidence that patients with MET, RET, or HER2 mutations may benefit from specifically targeted therapy, but these treatments have not yet been approved in patients with lung cancer. The optimal extent and overall clinical utility of broader molecular testing remain to be fully defined.”

“Molecular diagnostic testing is now part of the standard management of patients with non-small cell lung cancer,” he mentioned. “More attention needs to be paid to obtaining ample biopsy samples and developing efficient mechanisms to get molecular testing done in a timely manner.”

“This is a very rapidly evolving field with a continuous high flow of new data,” Dr. Kalemkerian added. “It is difficult for the practicing oncologist to keep up with advances in many different cancers, which is why it is very important for organizations such as ASCO to support expert guideline panels that can distill the literature down to digestible, clinically relevant highlights.”


JAMA Oncol 2018.

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