Testing for EGFR Mutations and ALK Rearrangements in Advanced Non-Small-Cell Lung Cancer: Considerations for Countries in Emerging Markets
Mercedes Liliana Dalurzo, Alejandro Avilés‐Salas, Fernando Augusto Soares, Yingyong Hou, Yuan Li, А. М. Строганова, Büğe Öz, Arif Abdillah, Hui Wan, Yoon‐La Choi
Abstract
Abstract: The treatment of patients with advanced non-small-cell lung cancer (NSCLC) in recent years has been increasingly guided by biomarker testing. Testing has centered on driver genetic alterations involving the epidermal growth factor receptor ( EGFR ) and anaplastic lymphoma kinase ( ALK ) rearrangements. The presence of these mutations is predictive of response to targeted therapies such as EGFR tyrosine kinase inhibitors (TKIs) and ALK TKIs. However, there are substantial challenges for the implementation of biomarker testing, particularly in emerging countries. Understanding the barriers to testing in NSCLC will be key to improving molecular testing rates worldwide and patient outcomes as a result. In this article, we review EGFR mutations and ALK rearrangements as predictive biomarkers for NSCLC, discuss a selection of appropriate tests and review the literature with respect to the global uptake of EGFR and ALK testing. To help improve testing rates and unify procedures, we review our experiences with biomarker testing in China, South Korea, Russia, Turkey, Brazil, Argentina and Mexico, and propose a set of recommendations that pathologists from emerging countries can apply to assist with the diagnosis of NSCLC. Keywords: non-small-cell lung cancer, EGFR testing, ALK testing, immunohistochemistry, FISH, next-generation sequencing