Operational strategies in molecular profiling of lung cancers

Lung cancer management has changed over the last few years with several actionable targets being recognised and mandated in the optimal management of these patients. The biomarker ordering practices have also changed with multidisciplinary communication becoming the key to successful strategies.

We present our experience in a tertiary care cancer setup. The transition from sequential testing to ordering multigene panels had taken place few years ago. The single gene panel was done using several strategies that included RT PCR for EGFR, Immunohistochemistry for ALK and ROS1 by FISH. With the Next Generation Sequencing (NGS) being included in the diagnostic armamentarium, the feasibility of testing several genes in one go has become a reality with significant reductions in cost and turnaround time. The advantages also including making the assays more comprehensive including mutations and fusions.

However, though theoretically, NGS offered a potential advantage, there were several operational challenges. The oncologists order the tests as per standard guidelines but whether it is to be taken up for NGS testing or single gene testing as alluded to earlier needs to be ascertained by the pathologist based on the availability of tissue, balancing the turn around time and cost. Visual indicators during the cycle of events that lead to preparation of paraffin embedded blocks has helped optimise the precious lung cancer tissue.

A coordinated effort between medical oncologists, pathologists radiologists, molecular biologists and histotechnologists helps address these issues and reap the benefits of NGS testing and management of lung cancers.