Molecular Testing and Actionable Targets in NSCLC

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In this segment, Mark A. Socinski, MD, addresses the topic of which molecular tests should be administered. In terms of actionable targets EGFR and EML4-ALK are the most important mutations to test for in day-to-day practice, since guidelines dictate a standard of care for patients with these mutations. At this point, testing for KRAS, ROS1, and BRAF may only be actionable within the confines of a clinical trial.

There is some discrepancy as to whether testing for multiple mutations should be conducted concurrently or sequentially. Corey J. Langer, MD, notes that as tissue depletes and patients are ill it may be best to use tissue efficiently by screening for the most common and actionable aberrations first, which are EGFR and EML4-ALK. Socinski notes that although ROS1 or other mutations may be rare, when they are found it makes a big difference.

In the future, the panel agrees, oncologists may have to test for ROS1, BRAF, and KRAS, as those mutations may have actionable targets in the near future.