Guidance on when and who to test
CAP/IASLC/AMP guidance on when to test
- Molecular testing should be initiated as soon as a diagnosis of adenocarcinoma is established
- As an absolute minimum, EGFR, ALK, and ROS1 testing must be offered by all laboratories that test lung cancers
CAP/IASLC/AMP guidance on who to test
- Mutational testing is strongly recommended in all patients with NSCLC favour adenocarcinomas, regardless of histological grade
- Physicians may use molecular biomarker testing in tumors with histologies other than adenocarcinoma when clinical features indicate a higher probability of an oncogenic driver.
- Clinical characteristics should not be used to either select or exclude patients from testing for ROS1 rearrangements.
- If there are apparently separate primary tumors, each may be tested; testing multiple areas within a single tumor is not necessary
- Primary tumors and metastatic lesions are equally suitable for testing
- Testing patients with stage I, II and III disease is encouraged but the decision to do so should be made locally