Molecular testing for advanced non-small cell lung cancer in Malaysia: Consensus statement from the College of Pathologists, Academy of Medicine Malaysia, the Malaysian Thoracic Society, and the Malaysian Oncological Society

Abstract

In the recent years, increased understanding of the molecular profiles of non-small cell lung cancer (NSCLC) has allowed for targeted treatment of actionable genetic mutations. The management of NSCLC now requires multiple molecular tests to guide the treatment strategy. In the light of this, there is a need to establish a molecular testing consensus statement for advanced NSCLC patients in Malaysia. This Malaysian consensus statement was developed by a panel of experts, chaired by a pathologist and composed of three other pathologists, four respiratory physicians and three oncologists. It reflects currently available scientific data and adaptations of recommendations from international guidelines to the local landscape. Expert recommendations on different aspects of molecular testing agreed upon by the panel are provided as structured discussions. These recommendations address the appropriate patients and samples to be tested, as well as when and how these tests should be performed. The algorithms for molecular testing in metastatic NSCLC, in the first line setting and upon disease progression beyond first line therapy, were developed.

Lung Cancer in Malaysia

“…These tests are primarily used to detect early In 2019, a consensus statement on molecular testing for advanced NSCLC patients localized to the Malaysian setting was published for the benefit of Malaysian health care practitioners involved in the management of advanced NSCLC patients. 17…”

mIR-99a-5p and mIR-148a-3p as Candidate Molecular Biomarkers for the Survival of Lung Cancer Patients

“…To date, various treatments are being used to slow cancer cell progression and increase overall patient survival, including chemotherapy, radiotherapy, targeted therapy, and surgical and traditional methods (Kan & Chan, 2016). However, many challenges occur during the treatment process, including the lack of specialists, especially thoracic surgeons, clinical and radiation oncologists, 88 Abdullah-Zawawi et al 2023 insufficient data in the national cancer registry, expensive treatment costs that specifically involve molecular testing and most importantly, lack of awareness among Malaysians to do screening test especially when they already in the late stage III and IV (Rajadurai et al, 2019).…”

Common driver mutations and programmed death-ligand 1 expression in advanced non-small cell lung cancer in smokers and never smokers

“…15,16 The PD-L1 expression of NSCLC and three driver mutations including EGFR mutation, ALK rearrangement and ROS1 rearrangement are recommended as the necessary biomarkers to be tested by our national consensus statement. 17 This study aimed to determine the relationship between the presence of common driver mutations and PD-L1 expression in NSCLC with smoking in a Malaysian population which is known to have a high prevalence of EGFR mutation and a lower proportion of smokers compared to the West. 3,4,18 There are no local Malaysian studies on the smoking status of patients and the degree of PD-L1 expression in NSCLC.…”

“…Testing for ALK rearrangement was only carried out in biopsy specimens which were tested negative for EGFR mutation and testing for ROS1 rearrangement was only carried out when both EGFR and ALK alterations were not detected in a 3-step testing protocol since these molecular alterations are mutually exclusive. 17 For PD-L1 detection and quanti cation of the degree of expression, Roche Diagnostics Ventana PD-L1 (SP263) Assay (Tucson, Arizona, USA) was used which is intended for the qualitative detection of the PD-L1 protein in NSCLC. It utilizes a rabbit monoclonal antibody that binds to PD-L1 in FFPE tissue sections.…”