Expert consensus recommendations on biomarker testing in metastatic and non-metastatic non-small cell lung cancer in Asia

Published:November 12, 2022DOI:
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      Most published guidelines for genomic biomarker testing in non-small cell lung cancer (NSCLC) reflect the disease epidemiology and treatments readily available in Europe and North America. However, 60% of annual global NSCLC cases occur in Asia, where patient characteristics, tumor molecular profiles, and treatments vary greatly from the Western world. For example, mutations in the epidermal growth factor receptor (EGFR) occur at a higher prevalence in Asia than in other world regions. Although medical associations such as IASLC, ESMO, and ASCO have described principles for tumor genomic biomarker testing in NSCLC, there is a need for recommendations specific for Asia. This report provides consensus recommendations for NSCLC biomarker testing from Asian lung cancer experts, for clinicians working in Asia to improve patient care. These recommendations are divided into non-metastatic and metastatic forms of adenocarcinoma and squamous cell carcinoma. Biomarker testing approaches for actionable genetic alterations in EGFR, ALK, ROS1 and others are discussed. Owing to the higher prevalence of EGFR mutations in Asia, the experts emphasized the need for EGFR testing to include not just common mutations (exon 19 deletions & L858R substitutions) but also other uncommon EGFR mutations. In addition to the assessment of biomarkers in tumor tissue, the role of assessing tumor biomarkers by liquid biopsy are also discussed.