Dr. Gandara on Patient Selection for Molecular Testing

David R. Gandara, MD, Director, Thoracic Oncology Program, University of California, Davis Comprehensive Cancer Center, discusses factors that help determine which patients with lung cancer should be tested for molecular aberrations.

Gandara believes that the best approach for determining whom to test is still debatable. However, new guidelines from IASLC and CAP recommend that all patients with adenocarcinoma should be tested for molecular abnormalities.

For EGFR and ALK aberrations, it has been suggested that the most cost-effective approach involves testing only never-smokers who have adenocarcinomas. However, Gandara explains that many former or light smokers are testing positive. The increasing frequency of these reports confirms the recommendations within the guidelines to test all patients with adenocarcinoma.

Moreover, Gandara notes that some patients with squamous cell carcinoma are also exhibiting ample actionable abnormalities that warrant molecular testing.