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
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 .
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Screening for EGFR oncogenic mutations in non-small cell lung cancer is essential to determine eligibility for targeted therapies in late-stage non-small cell lung cancer.
“The EGFR oncogenic mutation screening in non-small cell lung cancer is essential to determine eligibility for targeted therapies in late stage non-small cell lung cancer67.”
From A foundation model for clinical-grade computational pathology and rare cancers detection (2024) · cites this paper as [67]
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- Authors
- Kalemkerian, G. P., Narula, N., Kennedy, E. B., Biermann, W. A., Donington, J., Leighl, N. B., Lew, M., Pantelas, J., Ramalingam, S. S., Reck, M., Saqi, A., Simoff, M., Singh, N., & Sundaram, B.
- Affiliations
- American Society of Clinical Oncology (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2018-03-20
- Volume
- 36
- Issue
- 9
- Pages
- 911-919
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2785515282
- Cited by
- 492
- References
- 7
- Citations by year
- 2026: 21 · 2025: 23 · 2024: 60 · 2023: 58 · 2022: 59 · 2021: 85 · 2020: 95 · 2019: 60 · 2018: 31
- FWCI
- 51.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer Genomics and Diagnostics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- lung cancer, molecular testing, tyrosine kinase inhibitors, targeted therapy, patient selection, EGFR, ROS1, RET, HER2, KRAS, MET, BRAF, lung adenocarcinoma, non-small cell lung cancer, cell-free DNA, immunohistochemistry, tumor mutational burden
- MeSH terms
- Genetic Testing, Humans, Immunohistochemistry, Lung Neoplasms, Protein-Tyrosine Kinases, Proto-Oncogene Proteins, Proto-Oncogene Proteins p21(ras), Practice Guidelines as Topic, Receptor, ErbB-2, Erb-b2 Receptor Tyrosine Kinases, Proto-Oncogene Proteins c-met, Protein Kinase Inhibitors, ErbB Receptors
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