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Best practices in epidermal growth factor receptor T790M testing for advanced non-small-cell lung cancer in Hong Kong
J S F Nyaw1, K M Cheung2, F Hioe3
1Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China.
Abstract:
The T790M mutation in the epidermal growth factor receptor gene causes most acquired resistance to firstor second-line epidermal growth factor receptor-tyrosine kinase inhibitors in advanced non-small-cell lung cancer. The results of T790M testing can guide subsequent treatment. Despite the availability of guidelines from international organisations, T790M testing practices in Hong Kong must be streamlined and adapted to the Hospital Authority setting. To address this issue, a panel of experts in oncology and pathology met for discussion of key topics regarding T790M testing practices in Hong Kong, including the appropriate timing of testing and re-testing, as well as optimal testing methods. All panel members voted on the results of the discussion to achieve consensus. Items supported by a majority vote were adopted as consensus statements regarding current best practices for T790M testing in Hong Kong. Among the topics discussed, the panel agreed that T790M testing should be initiated upon radiological progression, including symptomatic disease progression or central nervous system-only progression. The experts also preferred initial testing with liquid biopsy, using the widely available digital polymerase chain reaction platform. This document provides the final consensus statements, as well as a testing and treatment workflow, for clinicians in Hong Kong to use as guidance in T790M testing.
Insights
Testing for the T790M mutation in epidermal growth factor receptor (EGFR) is crucial for guiding lung cancer treatment. Experts recommend initiating T790M testing upon progression, favoring liquid biopsy with digital PCR.
Area of Science:
- Oncology
- Molecular Diagnostics
- Genetics
Background:
- Acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in advanced non-small-cell lung cancer is often driven by the T790M mutation.
- Current international guidelines exist, but T790M testing practices in Hong Kong require standardization within the Hospital Authority framework.
Purpose of the Study:
- To establish consensus-based best practices for T790M mutation testing in Hong Kong.
- To provide a streamlined testing and treatment workflow for clinicians managing advanced non-small-cell lung cancer.
Main Methods:
- A panel of oncology and pathology experts convened to discuss and achieve consensus on key aspects of T790M testing.
- Consensus was reached through majority voting on topics including testing timing, re-testing, and optimal methodologies.
- The panel recommended specific testing and treatment workflows.
Main Results:
- Consensus was achieved on initiating T790M testing at the time of radiological progression, encompassing symptomatic or central nervous system-only progression.
- The preferred initial testing method is liquid biopsy utilizing the digital polymerase chain reaction (dPCR) platform.
Conclusions:
- The established consensus statements provide practical guidance for T790M testing in Hong Kong.
- Implementing these recommendations can optimize treatment selection for patients with advanced non-small-cell lung cancer experiencing acquired resistance to EGFR-TKIs.
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