. Step 34 of 41
Clinical Stem 3
A patient with right upper lobe adenocarcinoma progressing on biomarker-directed therapy

Answer C
Reflex testing is also known as automatic testing. It is often done by pathologists at the time of histologic diagnosis to ensure that complete histologic and molecular profiles of the tumor are available to the oncologist as early in the treatment algorithm as possible.

There are reports of discordance in molecular alterations between the primary tumor and nodal metastasis with similar histology. In addition, histologic discrepancy between the primary tumor and associated lymph nodes with similar molecular alterations has also been reported. Discussions with the referring oncologists and the pathologists are important prior to ordering molecular tests. Streamlining the institution's workflow for molecular markers is desirable.

Experts propose developing an institutional multidisciplinary lung cancer tissue management committee to decide which patients should undergo molecular testing and which tests should be performed. Guidelines from The European Society of Medical Oncologists as well as the CAP/IASLC/AMP guidelines do not currently recommend routine testing for KRAS, BRAF, ERBB2, or PIK3CA somatic gene mutations outside of clinical trials. Routine testing for mRNA levels of ERCC1, RRM1, TS and BRCA1 is not currently recommended outside of clinical trials.

Click here to download supplement materials (1)

Click here to download supplement materials (2)

References:
  1. Mino-Kenudson M, Mark EJ. Reflex testing for epidermal growth factor receptor mutation and anaplastic lymphoma kinase fluorescence in situ hybridization in non-small cell lung cancer. Arch Pathol Lab Med. 2011 May; 135(5):655-64
  2. Travis WD, Rekhtman N. Pathological diagnosis and classification of lung cancer in small biopsies and cytology: strategic management of tissue for molecular testing. Semin Respir Crit Care Med. 2011;32(1):22-31.
  3. Felip E, Gridelli C, Baas P et al. Metastatic nonsmall cell lung cancer: consensus on pathology and molecular tests, first line, second line, and third line therapy: 1st ESMO consensus conference in lung cancer. Annals of Oncology 2011; 22:1507?1519, 2011.
Each fictitious clinical case scenario is based on a conglomerate of real patient data. Cases have been modified to avoid any possibility for patient identification and to help meet educational objectives. Any resemblance to real persons, living or deceased, is purely coincidental.

The content for these webcasts has been developed by members of the World Association for Bronchology and Interventional Pulmonology. All content was reviewed by an independent multidisciplinary team of experts. Unless otherwise specified, all content is the property of WABIP.
A collaborative project with Pfizer Oncology