Consensus Recommendations to Optimize Testing for New Targetable Alterations in Non-Small Cell Lung Cancer

Diana N Ionescu¹, Tracy L Stockley^{2

3}, Shantanu Banerji^{4

5}, Christian Couture⁶, Cheryl A Mather⁷, Zhaolin Xu^{8

9}, Normand Blais¹⁰, Parneet K Cheema¹¹, Quincy S-C Chu¹², Barbara Melosky¹³, Natasha B Leighl¹⁴

Affiliations

¹ BC Cancer, Department of Pathology, Vancouver, BC V5Z 4E6, Canada.
² Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON M5G 2C4, Canada.
³ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada.
⁴ CancerCare Manitoba Research Institute, Winnipeg, MB R3E 0V9, Canada.
⁵ Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada.
⁶ Service of Anatomic Pathology and Cytology, Institut Universitaire de Cardiologie et de Pneumologie de Quebec-Université Laval, Québec City, QC G1V 4V5, Canada.
⁷ Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, Edmonton, AB T6G 2B7, Canada.
⁸ Department of Pathology, QE II Health Sciences Centre, Halifax, NS B3H 1V8, Canada.
⁹ Department of Pathology, Dalhousie University, Halifax, NS B3H 4R2, Canada.
¹⁰ Hematology-Oncology Service, Department of Medicine, Centre Hospitalier de l'Université de Montréal, 1051, Rue Sanguinet, Montreal, QC H2X 3E4, Canada.
¹¹ William Osler Health System, University of Toronto, Brampton, ON L6R 3J7, Canada.
¹² Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada.
¹³ BC Cancer-Vancouver Centre, Vancouver, BC V5Z 4E6, Canada.
¹⁴ Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada.

PMID: 35877256
PMCID: PMC9318743
DOI: 10.3390/curroncol29070396

Review

Consensus Recommendations to Optimize Testing for New Targetable Alterations in Non-Small Cell Lung Cancer

Diana N Ionescu et al. Curr Oncol. 2022.

. 2022 Jul 15;29(7):4981-4997.

doi: 10.3390/curroncol29070396.

Authors

Affiliations

¹ BC Cancer, Department of Pathology, Vancouver, BC V5Z 4E6, Canada.
² Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON M5G 2C4, Canada.
³ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada.
⁴ CancerCare Manitoba Research Institute, Winnipeg, MB R3E 0V9, Canada.
⁵ Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada.
⁶ Service of Anatomic Pathology and Cytology, Institut Universitaire de Cardiologie et de Pneumologie de Quebec-Université Laval, Québec City, QC G1V 4V5, Canada.
⁷ Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, Edmonton, AB T6G 2B7, Canada.
⁸ Department of Pathology, QE II Health Sciences Centre, Halifax, NS B3H 1V8, Canada.
⁹ Department of Pathology, Dalhousie University, Halifax, NS B3H 4R2, Canada.
¹⁰ Hematology-Oncology Service, Department of Medicine, Centre Hospitalier de l'Université de Montréal, 1051, Rue Sanguinet, Montreal, QC H2X 3E4, Canada.
¹¹ William Osler Health System, University of Toronto, Brampton, ON L6R 3J7, Canada.
¹² Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada.
¹³ BC Cancer-Vancouver Centre, Vancouver, BC V5Z 4E6, Canada.
¹⁴ Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada.

PMID: 35877256
PMCID: PMC9318743
DOI: 10.3390/curroncol29070396

Abstract

Non-small cell lung cancer (NSCLC) has historically been associated with a poor prognosis and low 5-year survival, but the use of targeted therapies in NSCLC has improved patient outcomes over the past 10 years. The pace of development of new targeted therapies is accelerating, with the associated need for molecular testing of new targetable alterations. As the complexity of biomarker testing in NSCLC increases, there is a need for guidance on how to manage the fluid standard-of-care in NSCLC, identify pragmatic molecular testing requirements, and optimize result reporting. An expert multidisciplinary working group with representation from medical oncology, pathology, and clinical genetics convened via virtual meetings to create consensus recommendations for testing of new targetable alterations in NSCLC. The importance of accurate and timely testing of all targetable alterations to optimize disease management using targeted therapies was emphasized by the working group. Therefore, the panel of experts recommends that all targetable alterations be tested reflexively at NSCLC diagnosis as part of a comprehensive panel, using methods that can detect all relevant targetable alterations. In addition, comprehensive biomarker testing should be performed at the request of the treating clinician upon development of resistance to targeted therapy. The expert multidisciplinary working group also made recommendations for reporting to improve clarity and ease of interpretation of results by treating clinicians and to accommodate the rapid evolution in clinical actionability of these alterations. Molecular testing of all targetable alterations in NSCLC is the key for treatment decision-making and access to new therapies. These consensus recommendations are intended as a guide to further optimize molecular testing of new targetable alterations.

Keywords: NSCLC; biomarker; genomic profiling; next-generation sequencing; targeted therapy.

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Conflict of interest statement

D.N.I reports an institutional grant from Roche, honoraria from AstraZeneca, Pfizer, BMS, Roche, Merck, Amgen, Eli Lilly, and Bayer, support for attending meetings from Pfizer, participation in a stat safety monitoring board or advisory board from Astra Zeneca, Pfizer, BMS, Roche, Merck, Amgen, Eli Lilly, and Bayer, and a leadership/fiduciary role with Lung Cancer Canada. T.L.S. reports payment/honoraria for advisory boards from Janssen and Bristol Myers Squibb. S.B. reports institutional grants from AstraZeneca and Roche, consulting fees from Pfizer, Bayer, Novartis, and Janssen, and honoraria from Bayer and AstraZeneca. C.C. reports an ongoing institutional grant from Merck, ongoing payment/honoraria for presentations from AstraZeneca, and participation in a data safety board/advisory board at Institut d’Excellence en Santé et en Services Sociaux (INESSS) of the Ministère de la Santé et des Services Sociaux (MSSS) du Québec. C.A.M. reports consulting fees and payment/honoraria from Bayer Canada, Pfizer Canada, Eli Lilly, Merck Canada, and Roche Diagnostics. N.B. reports consulting fees from Amgen, AstraZeneca, Bayer, BeiGene, BMS, EMD Serono, Ipsen, Merck, Novartis, Pfizer, Roche, Sanofi, Servier, and Takeda. P.K.C. reports consulting fees from AstraZeneca, Bristol Myers Squibb, Amgen, Novartis, Pfizer, Merck, EMD Serono, BeiGene, Sanofi, Janssen, and Hoffman LaRoche, and payment/honoraria for presentations from Merck, Amgen, and BMS. Q.S-C.C. reports an institutional grant from AstraZeneca, consulting fees from AbbVie, Amgen, AnHeart, Astellas, AstraZeneca, BMS, BI, Eli Lilly, Jazz, Merck, Novartis, Pfizer, Roche, and Sanofi Takeda, honoraria from AstraZeneca and BMS, participation in a data safety monitoring board/advisory board with Merck KGaA, and an unpaid leadership/fiduciary role at Lung Cancer Canada. B.M. reports payment/honoraria for lectures/presentations from Merck, BMS, Roche, Novartis, AZ, Pfizer, and Janssen, support for attending meetings/travel from Pfizer, participation in a data safety board/advisory board from Merck, BMS, Roche, Novartis, AZ, Pfizer, and Janssen. N.B.L. reports institutional grants from Amgen, Array, Astra Zeneca, Bayer, BMS, Inivata, MSD, Novartis, Pfizer, Roche, Eli Lilly, EMD Serono, Guardant Health, and Takeda, honoraria for CME lectures from Amgen, BMS, GlaxoSmithKline, MSD, Novartis, Puma Biotechnology, Sanofi Genzyme, and Takeda, and participation on a data safety monitoring board or advisory board from Helsinn. All authors report honoraria from Janssen Canada for participation in the working group meetings, following which the submitted manuscript was drafted.

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Consensus Recommendations to Optimize Testing for New Targetable Alterations in Non-Small Cell Lung Cancer

Affiliations

Consensus Recommendations to Optimize Testing for New Targetable Alterations in Non-Small Cell Lung Cancer

Authors

Affiliations

Abstract

Conflict of interest statement

References

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Full Text Sources

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