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AMP, CAP, IASLC Plan Revisions to Lung Cancer Molecular Testing Guidelines

NEW YORK (GenomeWeb) – The rapid advances in the field of molecular testing for lung cancer are forcing leading scientific organizations to revise recently issued medical guidelines.

The College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP) announced yesterday that they will be revising their guideline, "Molecular Testing Guideline for Selection of Lung Cancer Patients for Epidermal Growth Factor Receptor and ALK Tyrosine Kinase Inhibitors." The document addresses which patients and samples to test as well as when and how to perform those tests.

Revisions will be recommended by an expert panel made up of leaders in the field from around the world and will include new recommendations for ALK testing. The experts will review ALK-EGFR resistance and a number of emerging molecular targets including, ROS1, MET, ERBB2, RET, and NTRK1. They will reassess multiplexed next-generation sequencing panels, the use of immunohistochemistry, and the role of re-biopsy and repeat analysis in the setting of post-treatment relapse. Testing blood samples for mutations in circulating tumor cells, cell-free tumor DNA, and exosomes will be also be considered.

The revision process will start in early 2015 and should take about 18 months, the organizations said in a joint statement.

"Although only one year has passed since the molecular testing guideline was published, rapid accumulation of scientific knowledge and new evidence in this field indicate that the guidelines should be updated," Yasushi Yatabe, IASLC member and chief of the Department of Pathology and Molecular Diagnostics at Aichi Cancer Center in Nagoya, Japan, said in a statement. "Thus, an update has begun that includes an expanded list of genes and new methods that are clinically relevant.”

The committee will approach the revision in similar fashion to the initial guidelines, but will concentrate on a smaller number of topics to accelerate the process, said Neal Lindeman, director of molecular diagnostics at Brigham and Women's Hospital and associate professor of pathology at Harvard Medical School.

In October of 2014, The American Society of Clinical Oncology Clinical Practice Guidelines Committee endorsed the CAP/IASLC/AMP guideline for EGFR and ALK molecular testing.