16Nov 2014

ASCO Endorses CAP/IASLC/AMP Guideline on EGFR and ALK Molecular Testing for Patients with Lung Cancer
October 13, 2014
Kirsten Goldberg

Lung CancerALEXANDRIA, Va. — The American Society of Clinical Oncology (ASCO) today issued an endorsement of the joint College of American Pathologists (CAP)/International Association for the Study of Lung Cancer (IASLC)/Association for Molecular Pathology (AMP) clinical practice guideline on molecular testing for selection of patients with lung cancer for therapies targeting epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK). The guideline defines which patients should be offered EGFR and ALK genetic testing, and when and how such testing should be performed. ASCO’s endorsement provides doctors much-needed direction in a rapidly moving field.

“This guideline is incredibly important, as it increases the ability to personalize lung cancer care and improve outcomes for patients with advanced lung cancer,” said Natasha B. Leighl, MD, MSc, co-chair of ASCO’s Expert Panel that endorsed the guideline. “It describes the current evidence and helps oncologists and pathologists understand and put molecular testing into clinical practice.”

Very difficult to treat at late stages, lung cancer is the leading cause of cancer-related deaths among men and women. Several targeted treatment options are now available for patients with advanced non-small cell lung adenocarcinoma, the most common subtype of lung cancer. These treatments, including EGRF-targeting drugs erlotinib and afatinib and ALK-targeting drugs crizotinib and ceritinib, can shrink tumors and slow disease progression — but they only work in patients with specific changes in the EGFR or ALK genes. Prompt and reliable molecular testing is critical for ensuring that all patients who are candidates for such therapy are identified.

“This guideline will help standardize which patients are tested and when and how the testing is implemented,” said Natasha Rekhtman, MD, PhD, co-chair of ASCO’s Expert Panel that endorsed the guideline. “We hope that it will encourage testing and treatment based on molecular results.

The ASCO Expert Panel reviewed the guideline content and concurred that the recommendations are clear, thorough, based on the most relevant scientific evidence, and present options that will be acceptable to patients. The guideline comprises 37 recommendations, expert consensus opinions, or suggestions.

Key guideline recommendations:

hpw style="text-align: justify;">Offer EGFR and ALK testing to all patients with lung adenocarcinoma (or mixed lung cancers with adenocarcinoma component), irrespective of characteristics such as gender, race and smoking status.
Laboratories can use a range of different testing methods, provided they meet certain technical requirements. Certain types of tests are not recommended.
Laboratories should adhere to guidance regarding specimen processing, testing validation, quality assurance, and turnaround times for reporting results.
The endorsement, Molecular Testing for Selection of Patients with Lung Cancer for Epidermal Growth Factor Receptor and Anaplastic Lymphoma Kinase 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 Guideline was published today in the Journal of Clinical Oncology. CAP, IASLC and AMP are currently updating their guideline based on new evidence regarding ALK testing, testing for molecular alterations associated with acquired resistance to EGFR and ALK inhibitors, new markers such as ROS1, RET, ERBB2 (HER2), BRAF, MET and next-generation sequence testing. ASCO Expert Panel members will work with their CAP, IASLC, and AMP counterparts to keep abreast of substantive updates to the current lung cancer testing guideline and determine the need to update the ASCO endorsement.

Information for patients on lung cancer is available at www.cancer.net/lung. The guideline is available at http://www.asco.org/endorsements/lungmarkers, along with supplementary materials.

ASCO encourages feedback on its guidelines from oncologists, practitioners and patients through the ASCO Guidelines Wiki at www.asco.org/guidelineswiki.


About the Journal of Clinical Oncology

Journal of Clinical Oncology, the flagship journal of the American Society of Clinical Oncology, is a leader in reach, readership, impact, and influence. With a focus on significant clinical oncology research, Journal of Clinical Oncology Published over 1,000 articles in 36 issues a year.

About ASCO

Founded in 1964, the American Society of Clinical Oncology (ASCO) is the world’s leading professional organization representing physicians who care for people with cancer. With more than 35,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds ground-breaking research and programs that make a tangible difference in the lives of people with cancer. For ASCO information and resources, visit www.asco.org. Patient-oriented cancer information is available at www.cancer.net.