The impact on the multidisciplinary team of molecular profiling for personalized therapy in non-small cell lung cancer.

Abstract

The composition of the multidisciplinary team (MDT) that treats lung cancer varies by region and practice setting but generally includes a thoracic medical oncologist, a thoracic surgeon, a thoracic radiation oncologist, and an interventional radiologist, as well as a pathologist, pulmonologist, and specialist nurses. Growing clinical evidence supports a personalized approach to non-small cell lung cancer (NSCLC) treatment, and clinical trials in advanced disease have shown the value of testing for epidermal growth factor receptor gene (EGFR) mutations prior to first-line therapy with erlotinib or gefitinib and testing for anaplastic lymphoma kinase gene (ALK) rearrangements prior to therapy with crizotinib. The most recent National Comprehensive Cancer Network (NCCN) guidelines also recommend sequential EGFR and ALK testing for patients with a diagnosis of recurrent or metastatic adenocarcinoma, large cell carcinoma, or not otherwise specified histology, and simultaneous molecular screening has also been proposed. Here, we explore potential challenges for the MDT implied by the move toward personalized therapy in NSCLC and the increasing need for molecular diagnoses, and anticipate how the working roles and responsibilities of team members may develop to accommodate them.