Molecular Testing Guideline for the Selection of Patients With Lung Cancer for Treatment With Targeted Tyrosine Kinase Inhibitors: American Society of Clinical Oncology Endorsement of the College of American Pathologists/International Association for the Study of Lung Cancer/Association for Molecular Pathology Clinical Practice Guideline Update

Author:

Kalemkerian Gregory P.1,Narula Navneet1,Kennedy Erin B.1,Biermann William A.1,Donington Jessica1,Leighl Natasha B.1,Lew Madelyn1,Pantelas James1,Ramalingam Suresh S.1,Reck Martin1,Saqi Anjali1,Simoff Michael1,Singh Navneet1,Sundaram Baskaran1

Affiliation:

1. Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram...

Abstract

Purpose In response to advances in the field, the College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP) recently updated their recommendations for molecular testing for the selection of patients with lung cancer for treatment with targeted tyrosine kinase inhibitors. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. Methods The molecular testing guideline was reviewed for developmental rigor by methodologists. Then an ASCO Expert Panel reviewed the content and the recommendations. Results The ASCO Expert Panel determined that the recommendations from the CAP/IASLC/AMP molecular testing guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the guideline with minor modifications. Recommendations This update clarifies that any sample with adequate cellularity and preservation may be tested and that analytical methods must be able to detect mutation in a sample with as little as 20% cancer cells. It strongly recommends against evaluating epidermal growth factor receptor (EGFR) expression by immunohistochemistry for selection of patients for EGFR-targeted therapy. New for 2018 are recommendations for stand-alone ROS1 testing with additional confirmation testing in all patients with advanced lung adenocarcinoma, and RET, ERBB2 (HER2), KRAS, and MET testing as part of larger panels. ASCO also recommends stand-alone BRAF testing in patients with advanced lung adenocarcinoma. Recommendations are also provided for testing methods for lung cancers that have a nonadenocarcinoma non–small-cell component, for patients with targetable mutations who have relapsed on targeted therapy, and for testing the presence of circulating cell-free DNA. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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