Public Release: 

Updated guideline for molecular testing and targeted therapies in lung cancer

Brigham investigators and clinical society colleagues set new standards for the molecular analysis of lung cancers to guide treatment decisions with targeted inhibitors.

Brigham and Women's Hospital

A panel of leading experts in molecular pathology has issued new recommendations and updates to guidelines for molecular diagnostic testing of patients with lung cancer. The new guidelines reflect recent advancements, as well as decades of work, to identify the genetic underpinnings of the leading cause of cancer-related deaths worldwide. They are intended to help guide the treatment of patients around the world, and help oncologists and pathologists match patients with the most effective therapies. Based on the panel's findings, published in The Archives of Pathology & Laboratory Medicine, three leading medical societies-- the College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP)--have updated their 2013 evidence-based guideline.

"These guidelines are intended to help improve and standardize the care of all patients who suffer from this disease," said Neal Lindeman, MD, director of Molecular Diagnostics at Brigham and Women's Hospital. "Our panel of international experts reflects the global nature of lung cancer - we hope that these updated guidelines will help providers around the world better interpret the effectiveness of therapies that are designed to target an individual cancer's genetic vulnerabilities."

Lindeman led an international, multidisciplinary panel of expert authors appointed by each of the three organizations. The panel included pathologists, oncologists, pulmonologists, a methodologist, laboratory scientists and patient representatives who collaborated to develop the guidelines by following the Institute of Medicine's evidence-based process.

The panel's findings include 18 new recommendations and three updates. These include updated recommendations regarding testing for EGFR - a gene first uncovered by investigators at BWH and elsewhere that can help determine if a patient will respond to a targeted therapy. The panel has also issued new recommendations regarding testing for several additional genes (ROS1, ERBB2, MET, BRAD, KRAS, and RET) for certain forms of cancer, or, in the case of some of these genes, as part of a next-generation sequencing panel.

The complete guideline is available online. Additionally, the CAP, IASLC and AMP developed resources to help pathologists and oncologists review and implement the guidelines, including a summary of recommendations, a teaching presentation, frequently asked questions, and a video series.


In addition to BWH, the panel included experts from Houston Methodist Hospital, Memorial Sloan Kettering Cancer Center, Critical Care and Sleep Medicine, Houston Methodist Research Institute, College of American Pathologists, University of Pittsburgh, University of Colorado, University of Aberdeen in Scotland, Roswell Park Cancer Institute, Association for Molecular Pathology, Peter Maccallum Cancer Center in Australia, VU University Medical Center in the Netherlands, Princess Margaret Cancer Center, International Association for the Study of Lung Cancer, and Aichi Cancer Center in Japan.

Authors' disclosures of potential conflicts of interest and author contributions are found in the Appendix at the end of this article.

Paper cited: Lindeman N et al. "Updated Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment With Targeted Tyrosine Kinase Inhibitors" Arch Pathol Lab Med DOI: 10.5858/arpa.2017-0388-CP

Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 4.2 million annual patient visits and nearly 46,000 inpatient stays, is the largest birthing center in Massachusetts and employs nearly 16,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 3,000 researchers, including physician-investigators and renowned biomedical scientists and faculty supported by nearly $666 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative as well as the TIMI Study Group, one of the premier cardiovascular clinical trials groups. For more information, resources and to follow us on social media, please visit BWH's online newsroom.

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