Abstract
The development and approval of both targeted and immune therapies for patients with advanced non-small cell lung cancer (nsclc) has significantly improved patient survival rates and quality of life. Biomarker testing for patients newly diagnosed with nsclc, as well as for patients progressing after treatment with epidermal growth factor receptor (EGFR) inhibitors, is the standard of care in Canada and many parts of the world. A group of thoracic oncology experts in the field of thoracic oncology met to describe the standard for biomarker testing for lung cancer in the Canadian context, focusing on evidence-based recommendations for standard-of-care testing for EGFR, anaplastic lymphoma kinase (ALK), ROS1, BRAF V600 and programmed death-ligand (PD-L1) at the time of diagnosis of advanced disease and EGFR T790M upon progression. As well, additional exploratory molecules and targets are likely to impact future patient care, including MET exon 14 skipping mutations and whole gene amplification, RET translocations, HER2 (ERBB2) mutations, NTRK, RAS (KRAS and NRAS), as well as TP53. The standard of care must include the incorporation of testing for novel biomarkers as they become available, as it will be difficult for national guidelines to keep pace with technological advances in this area. Canadian patients with nsclc should be treated equally; the minimum standard of care is defined in this paper.
Highlights
According to Canadian Cancer Statistics 20171, lung cancer is one of the most common malignancies, accounting for 14% of all newly diagnosed cancers in both genders
Canadian patients with nsclc should be treated ; the minimum standard of care is defined in this paper
Cytology samples are suitable for epidermal growth factor receptor (EGFR) testing, with cell blocks being widely preferred over smears
Summary
According to Canadian Cancer Statistics 20171, lung cancer is one of the most common malignancies, accounting for 14% of all newly diagnosed cancers in both genders. The development and approval of smallmolecule tyrosine kinase inhibitors (tkis) and immune therapies has significantly improved patient outcomes. The Lung Cancer Mutation Consortium found that two-thirds of non-small cell lung cancer (nsclc) patients with adenocarcinomas (adcs) have an oncogenic driver, and that when these patients receive the corresponding targeted agent, they will have improved survival and quality of life[3]. Biomarker testing is essential to identify patients eligible for targeted therapy. The development and approval of both targeted and immune therapies for patients with advanced non-small cell lung cancer (nsclc) has significantly improved patient survival rates and quality of life. Biomarker testing for patients newly diagnosed with nsclc, as well as for patients progressing after treatment with epidermal growth factor receptor (EGFR) inhibitors, is the standard of care in Canada and many parts of the world
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