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Recommendations of the Austrian Working Group on Pulmonary Pathology and Oncology for predictive molecular and immunohistochemical testing in non-small cell lung cancer

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Summary

The introduction of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) in the therapy of non-small cell lung cancer (NSCLC) with activating mutations of the EGF receptor has opened a new area of lung cancer treatment strategies and led to an enthusiastic search for additional genetic aberrations. Genetic drivers such as EML4-ALK (EML4: echinoderm microtubule-associated protein-like 4; ALK: anaplastic lymphoma kinase) and proto-oncogene tyrosine protein kinase transcribed from the ROS1-gene (ROS1) rearrangements have been detected and specific treatment options have been developed. A new approach to treatment in lung cancer is immunotherapy by antibodies interfering with immune checkpoint controls. Diagnostic and predictive immunohistochemical staining and molecular tests have to follow specific rules, if applied in daily practice. The Austrian Working Group on Pulmonary Pathology and Oncology (AWGPPO) has presented an updated version of the previous recommendations published in 2013. Questions raised during the past 3 years will be addressed: selection of tissue, order of diagnostic immunohistochemical and molecular tests, “reflex” testing, the issue of resistance mechanisms, significance of liquid biopsies, and use and interpretation of antibody reactions for immune checkpoint markers.

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Acknowledgements

MerckSharpDome (MSD) and Pfizer Austria provided the conference facilities for the above listed experts. The result of this discussion and the resulting manuscript was by no means influenced by the companies.

Author information

Authors and Affiliations

  1. Institute of Pathology, Medical University Graz, Graz, Austria

    Helmut H. Popper & Luka Brcic

  2. Consultant pathologist, Feldkirch, Austria

    Ulrike Gruber-Mösenbacher

  3. Institute of Pathology, Private University Salzburg, Salzburg, Austria

    Georg Hutarew

  4. Department of Pulmonology, Otto Wagner Hospital, Vienna, Austria

    Maximilian Hochmair & Andrea Mohn-Staudner

  5. Department of Oncology, Medical University Graz, Graz, Austria

    Gudrun Absenger

  6. Institute of Pathology, Medical University, Vienna, Austria

    Leonhard Müllauer & Gerhard Dekan

  7. Institute of Pathology, Otto Wagner Hospital, Vienna, Austria

    Ulrike Setinek & Dagmar Krenbek

  8. Institute of Pathology, Hospital Hietzing, Vienna, Austria

    Michael Vesely

  9. Department of Internal Medicine I, Medical University of Vienna – AKH, Vienna, Austria

    Robert Pirker

  10. 1st Department of Internal Medicine, Oncology and Haematooncology, Wilhelminen Hospital, Vienna, Austria

    Wolfgang Hilbe

  11. Department of Pulmonology, Hospital Wels-Grieskirchen, Wels-Grieskirchen, Austria

    Rainer Kolb

  12. Laboratory of Molecular Biology and Tumorcytogenetics, Internal Medicine I, Hospital of Barmherzige Schwestern, Linz, Austria

    Gerald Webersinke

  13. Department of Pulmonology, Hospital Hohenems, Hohenems, Austria

    Tamara Hernler

  14. Department of Internal Medicine 5 (Haematology and Oncology), Medical University Innsbruck, Innsbruck, Austria

    Georg Pall

  15. Department of Pathology, Hospital Graz West, Graz, Austria

    Sigurd Lax

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  1. Helmut H. Popper
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Corresponding author

Correspondence to Helmut H. Popper.

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Conflict of interest

Several authors have been paid for educational activities invited from pharmaceutical companies, and also act on advisory boards of these companies. H.H. Popper, U. Gruber-Mösenbacher, G. Hutarew, M. Hochmair, G. Absenger, L. Brcic, L. Müllauer, G. Dekan, U. Setinek, D. Krenbek, M. Vesely, R. Pirker, W. Hilbe, R. Kolb, G. Webersinke, T. Hernler, G. Pall, S. Lax, and A. Mohn-Staudner declare that they have no competing interests for this article.

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Popper, H.H., Gruber-Mösenbacher, U., Hutarew, G. et al. Recommendations of the Austrian Working Group on Pulmonary Pathology and Oncology for predictive molecular and immunohistochemical testing in non-small cell lung cancer. memo 9, 191–200 (2016). https://doi.org/10.1007/s12254-016-0297-x

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  • DOI: https://doi.org/10.1007/s12254-016-0297-x

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