How can societies help to implement personalised treatment?

There were two lectures about the role of the European Society for Medical Oncology (ESMO) and the International Association for the Study of Lung Cancer (IASLC) to help implement personalised treatment in clinical practice.

ESMO provides tools that help in decision-making. In the recently updated ESMO guidelines, there are recommendations about which molecular aberrations could be present and how they should be tested. For the diagnosis of stage 4 lung cancer, the following molecular tests are recommended: ALK, BRAF, EGFR, and ROS1. Based on the aberrations present, a certain targeted therapy or several treatment options can be recommended [1]. “ESMO is not only intended for Europe and for medical oncologists, but ESMO expands to all professions”, Prof. Rolf Stahel (University Hospital of Zurich, Switzerland) said. Recently, the Asian colleagues adapted the ESMO guidelines and published an Asian version [2]. In Asia, physicians see more patients with squamous cell lung cancer who are non- or never-smokers. The recommendation is to look at those patients separately and to perform specific molecular testing.

During the final lecture of this session, Prof. Giorgio Scagliotti (University of Turin, Italy) talked about role of the IASLC. Its mission is primarily to provide education on a global scale. IASLC does not publish therapeutic guidelines or perform clinical studies (directly or indirectly through sister organisations), clinical-molecular correlative studies, pre-clinical research (only through individual grants by the Foundation), and pharmaco-economy or health technological assessment.

Jumping in on a hot topic, Prof. Scagliotti mentioned a recent statement paper from the IASLC about liquid biopsy for advanced NSCLC [3]. “In treatment-naïve patients, liquid biopsy is an opportunity if you are not able to obtain tissue for several reasons.” A first statement is that liquid biopsies have brought enormous improvements in the management of NSCLC patients. Technologies that detect EGFR-sensitising alterations in peripheral blood in patients with treatment-naïve NSCLC have reached such high reliability that their use in clinic is highly recommended. The clinical reliability with respect to the detection of ALK alterations and BRAF mutations needs to be further validated [3]. According to Prof. Scagliotti, liquid biopsies are far from replacing tumour biopsy in clinical practice. “We need accuracy studies and different platforms.”

The next big things in which the IASLC is involved, include the publication of the 9th edition of the TNM staging system and the IASLC Early Imaging Confederation (ELIC) project. In addition, Prof. Scagliotti thinks it is time to promote a large, multi-stakeholders alliance against lung cancer to improve survival significantly. Furthermore, the IASLC is committed to help regional organisations about smoking cessation, nursing, and/or advocacy. Finally, the IASLC is a consulting body for policy makers in different areas of the world to facilitate new drug access.

1. Planchard D, et al. Ann Oncol. 2018;29(Supplement_4):iv192-iv237.
2. Wu YL, et al. Ann Oncol. 2019;30:171-210.
3.  Rolfo C, et al. J Thorac Oncol. 2018;13:1248-1268.

Posted on 25 June 201915 March 2021