Chapter 10
Summary and Future Perspectives
By Fred R. Hirsch, Yasushi Yatabe, and Ming Sound Tsao
Treatment results for patients with advanced NSCLC harboring ALK gene rearrangement continues to be encouraging, and the diagnosis of these rearrangements remains challenging. It is now wellestablished that molecular testing for ALK gene rearrangement is crucial for the optimal choice of therapy for patients with advanced NSCLC, particularly tumors that are an adenocarcinoma or have an adenocarcinoma component. However, several questions still await definite answers. 1. Which patients should be screened for ALK gene rearrangement? 2. What is the most cost-effective screening method? 3. What is the most optimal screening-diagnosis paradigm for selecting patients for treatment with ALK inhibitors in order to capture all the patients who may potentially benefit from this therapy? 4. What is the most optimal treatment paradigm based on the current clinical evidence? Although the last question is beyond the scope of this Atlas, the first three questions have been addressed.
Which Patients Should Be Screened for ALK Gene Rearrangement?
There seems to be consensus that, at minimum, screening for ALK gene rearrangement should be done for all patients with advanced NSCLC that is an adenocarcinoma or has an adenocarcinoma component. Depending on resources and academic interest, screening of p