New guideline sets the ground rules for routine molecular testing in non-small cell lung cancer

摘要

In the last decade there has been dramatic evolution of our understanding of non-small cell lung cancer (NSCLC). What was once thought of as a single common disease has emerged as a collection of relatively uncommon diseases with different genetic drivers,and the recognition of distinct molecular subtypes of NSCLC has led to the rapid adoption of new targeted drugs for the treatment of patients with epidermal growth factor receptor (EGFR) gene mutations and EML4/ALK gene rearrangements. Although personalized therapy is a worthy goal, the need to identify appropriate patients for molecularly targeted therapy has introduced multiple issues that need to be addressed by both pathologists and treating oncologists. Which NSCLC patients should be tested, how quickly must testing be performed, and when should that testing be performed in the disease process? What techniques are most appropriate, what are the tissue requirements for testing, and how should scarce tissue be prioritized? In an attempt to standardize practices and provide guidance on these issues, the College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP) have jointly issued a guideline for the selection of lung cancer patients for EGFR and ALK testing that should provide a framework for molecular testing going forward