Current Concepts in the Diagnosis of Lung Cancers BY THEINTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER ADELAIDE CONVENTION CENTER ADELAIDE, SOUTH AUSTRALIA, AUSTRALIA FELIPE S TEMPLO JR., MD
PHC data (1998-2003). Templo FS, Orillaza MA, Tan CD (2003)Correct specific diagnosis in 30% (38% SCC and 23% AdenoCA)NSCLC-NOS is 62% (22.6% SCC and 37.7% AdenoCa)Incorrect specific diagnosis is 7.5% (10% AdenoCA and 4.7% SCC)
LEPIDIC ACINARPAPILLARY MICROPAPILLARY SOLID WITH MUCIN
GENERAL RECOMMENDATIONS FOR EGFR/KRAS TESTING: Blocks (formalin-fixed, paraffin-embedded) are highly recommended for optimal testing. Testing can be performed on primary tumor or a site of metastasis 1) FFPE tissue block containing 20% to 25% tumor OR 2) 3-4 precut unstained slides from paraffin block in 5 micron sections and one H&E reference slide (manual microdissection) Use special slides for laser microdissection (7 micron) FFPE blocks from surgical resections, excisional biopsies, fine needle aspirates (FNA) and biopsy, core needle biopsies, cell blocks (pleural effusions, ascites and FNAs) and bone marrow. A minimum of 300-500 viable tumor cells are required.
TISSUE COLLECTION/FIXATION24 HOURS BIOPSY FIXATION/TISSUE PROCESSING PATHOLOGIST’S REVIEW AND 1-2 REPORT PATHOLOGYWORKINGDAYSEXCEPT DECISION FOR EGFR MUTATION ANALYSIS,IHC TUMOR CONTENT REVIEWED TUMOR MICRODISSECTION IF NEEDED MOLECULAR TESTING 5-7 WORKING EGFR MUTATION TESTING DAYS FINAL FINAL REPORT WITH TUMOR HISTOLOGY REPORT AND MUTATION RESULTS
NEW CANDIDATE PREDICTIVE MARKERS HER2 RAF PI3KCA–AKT–mTOR pathway C-MET Insulin-like growth factor (IGF1R) Fibroblastic growth factor receptor 1 (FGFR1) and discoidin domain receptor family, member 2 (DDR2) Target molecules for chemotherapeutic agents
Questions?1. Which Patients Should Be Tested for the Presence of These Mutations to Determine Their First-line Therapy Options? First, what is the chance of an activating mutation being present? Second, what is the cost of testing? How should testing be performed? Which mutations of the EGFR are clinically significant? 2011 by American Society of Clinical Oncology.
Questions?2. Should Patients with Less than 10 Packs/Year Smoking History and Non-squamous Histology Be Empirically Treated with Oral EGFR TKIs in the Absence of EGFR Testing?3. Should KRAS Testing Be Used to Deny Patients Therapy with Oral EGFR TKI Inhibitors?4. Is There a Role for EGFR FISH Testing When Considering the Use of First-generation Oral EGFR TKIs? 2011 by American Society of Clinical Oncology.
Questions?5. How Common Is ALK?6. What Are the Key Clinical Features Associated with ALK?7. Should All Patients with NSCLC Be Tested for ALK? 2011 by American Society of Clinical Oncology
Questions?8. Should Patients with EGFR or KRAS Mutant Lung Cancer be Tested for ALK?9. What Is the Diagnostic Test of Choice for ALK?10. Are There Other Diagnostic Modalities for ALK? 2011 by American Society of Clinical Oncology