The clinical guidelines for EGFRALK testing in lung cancer jointly issued by the American Association of Pathologists, the National Association for the Study of Lung Cancer and the Society for Molecular Pathology were released, some of which are translated below: Li Jindong, Department of Thoracic Surgery, Henan Cancer Hospital
I. When to perform molecular marker testing in NSCLC patients?1. Which patients should receive EGFR mutation and ALK rearrangement testing?
1.1a: EGFR mutation testing is recommended for all patients to receive targeted EGFR therapy; clinical characteristics such as age, gender, race or smoking history should not be used as a basis to recommend EGFR mutation testing for patients with lung adenocarcinoma. 1.1b: ALK mutation testing is recommended for all patients to receive targeted ALK therapy. 1.1b: ALK mutation testing is recommended for all patients to receive targeted ALK therapy; clinical characteristics such as age, gender, race, or smoking history cannot be used as a basis for recommending ALK mutation testing for patients with lung adenocarcinoma, nor can these clinical characteristics be used as a prerequisite for recommending ALK mutation testing for patients. EGFR and ALK testing is recommended; EGFR and ALK testing is not recommended for lung squamous, small cell, and large cell carcinomas without any adenocarcinoma component confirmed by immunohistochemistry.1.3: EGFR and ALK testing may be beneficial for some young, nonsmoking patients with squamous or small cell carcinomas whose diagnosis is based on tissue biopsy or cytology and for whom a lung adenocarcinoma component cannot be completely excluded. 1.4: In the case of primary treatment, samples obtained from primary tumors or metastases are equally suitable for EGFR and ALK testing.1.5: Experts agree that for biprimary or multiple primary lung adenocarcinomas, each lesion can be tested, but it is not necessary to test individual lesions from different sites.Question 2: When to test patients for EGFR mutations or ALK rearrangements 2.1a: Patients with IV lung adenocarcinoma suitable for targeted therapy, or patients with early stage but recurrent or progressive disease who have not been previously tested for EGFR. 2.1b: Patients with IV lung adenocarcinoma suitable for targeted therapy, or patients with early stage but recurrent or progressive disease who have not been previously tested for ALK. 2.2a: Experts agree that EGFR testing is encouraged in patients with I, II, and III lung adenocarcinoma because these patients can usually undergo surgical resection and have easy access to sufficient fresh testing samples, whereas waiting until progression or recurrence makes fresh samples less readily available. 2.2b: Experts agree that EGFR testing is encouraged in patients with I, II, and III lung adenocarcinoma because these patients can usually undergo surgical resection and have easy access 2.3: Tumor tissue should be prioritized for EGFR and ALK testing over other genetic testing.