Lung Cancer

Testing is available for Stage IIIB/IV non-small cell, non-neuroendocrine lung adenocarcinoma, for patients both prior to TKI therapy (pre-treatment) as well as following progression on TKI therapy.

Pre-treatment

Available molecular tests include targeted EGFR mutation analysis or Oncopanel multigene NGS panel.  Only one of these tests should be selected, both cannot be performed.

Targeted testing provides a quicker return of results than Oncopanel (approximately 7-10 days versus 14 days) and can accommodate specimens with lower tumour content.  The Oncopanel assay can detect targetable mutations in genes other than EGFR, including BRAF, MET (exon 14 skipping), and ERBB2.

Concurrently with the above molecular testing, pre-treatment lung cancer specimens will also be evaluated for PD-L1, ALK and ROS1 by IHC (see the BC Cancer Laboratory Services website for details). Equivocal (1+ or 2+) ALK specimens or positive ROS1 specimens will receive confirmatory FISH testing.

Progression

Targeted testing to detect the T790M TKI-resistance mutation in EGFR is offered for two different specimen types, FFPE surgical specimens (surgical or cytology) and plasma circulating tumour DNA:

The clinical sensitivity of plasma testing is highly dependent upon the release of tumour DNA into the circulation. For this reason, tissue collected post-progression (if available) may be a more informative specimen type for T790M testing.

NOTE: The Oncopanel assay is also capable of detecting EGFR T790M, however repeat panel testing at progression is not currently offered and one of these targeted tests should instead be ordered.