ASCO Endorses CAP/IASLC/AMP Guideline Update on Molecular Testing for Targeted Tyrosine Kinase Inhibitor Treatment in Lung Cancer

As reported in the Journal of Clinical Oncology by Gregory P. Kalemkerian, MD, and colleagues, ASCO has endorsed the College of American Pathologists (CAP), International Association for the Study of Lung Cancer (IASLC), and Association for Molecular Pathology (AMP) updated guideline on molecular testing for selection of lung cancer patients for targeted tyrosine kinase inhibitor treatment.

The endorsement was based on an ASCO expert panel review of the updated CAP/IASLC/AMP molecular testing guideline. The expert panel was co-chaired by Dr. Kalemkerian, of the University of Michigan, Ann Arbor, and Navneet Narula, MD, of Weill Cornell Medical College. ASCO endorsed the guideline with minor modifications. Key elements of the updated guideline are summarized below.

Key Elements

  • The updated guideline clarifies that any sample with adequate cellularity and preservation may be tested, and that analytic methods must be able to detect mutation in a sample with as little as 20% cancer cells.
  • The guideline strongly recommends against evaluating EGFR expression by immunohistochemistry for selection of patients for EGFR-targeted therapy.
  • New for 2017 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 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.

ASCO is the corresponding author for the Journal of Clinical Oncology article: e-mail: guidelines@asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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