Lung adenocarcinoma in the era of targeted therapies: histological classification, sample prioritization, and predictive biomarkers

Abstract

The arrival of targeted therapies has presented both a conceptual and a practical challenge in the treatment of patients with advanced non-small cell lung carcinomas (NSCLCs). The relationship of these treatments with specific histologies and predictive biomarkers has made the handling of biopsies the key factor for success. In this study, we highlight the balance between precise histological diagnosis and the practice of conducting multiple predictive assays simultaneously. This can only be achieved where there is a commitment to multidisciplinary working by the tumor board to ensure that a sensible protocol is applied. This proposal for prioritizing samples includes both recent technological advances and the some of the latest discoveries in the molecular classification of NSCLCs.

Fig. 1

A realistic approach for sample prioritization for the study of predictive biomarkers in patients with advanced lung ACs. Route A is for cases that require classificatory IHC while route B is for cases that are diagnosed based on the H&E alone. The relative frequency of the different genetic alterations is shown in parenthesis. Data from ROS1 translocation is taken from the literature [43]. The other percentages come from our own experience [41, 42], and unpublished data

Fig. 2

A simplified view of an integrated pathway for the study of predictive biomarkers in patients with advanced NSCLCs. There are two interesting aspects. a If the sampling is managed by the tumor board, there will be better sample prioritization than has happened previously. b There is an increased awareness of technological advantages and disadvantages among patients and their families