What genes should be tested before considering targeted drugs for lung cancer?

The clinical term “targeted therapy, test first” or “test first, treat later” refers to the need for genetic testing first.

So what are the genes that need to be routinely tested?

The US guidelines recommend routine testing for 8 genes: EGFR/ALK/ROS1/KARS/BRAF/HER2/MET/RET. Most of these targets already have drugs in the US or are in development.

In China, because many drugs have not yet been studied in clinical trials, the guidelines only recommend routine clinical testing for specific mutations in 3 genes: EGFR/ALK/ROS1.

T790M gene testing is recommended for patients who are resistant to EGFR-targeted drug therapy because this mutation is a common cause of resistance to EGFR-targeted drugs, and drugs are available (oseltinib, trade name Teresal).