ALK-Testung beim nicht-kleinzelligen Lungenkarzinom (NSCLC): Immunhistochemie (IHC) und/oder Fluoreszenz-in-situ-Hybridisierung (FISH)?^[*]

Zusammenfassung

EML4-ALK-Translokationen spielen eine wichtige Rolle in der Pathogenese des nicht-kleinzelligen Lungenkarzinoms. Die Identifizierung der Translokation und die Einleitung einer zielgerichteten Therapie gegen den alterierten EML4-Alk-Signalweg ist von zentraler Bedeutung für die Patienten. Die zielgerichtete Therapie ist mit einem signifikanten progressionsfreien- und Überlebensvorteil vergesellschaftet. Eine frühe Diagnosesicherung ist unabdingbar. Der Nachweis der EML4-ALK-Translokationen wurde bisher vornehmlich mittels FISH-Technik durchgeführt. Die Untersuchungsmethode zeichnet sich durch einen nicht unerheblichen Untersuchungsaufwand aus. Immunhistochemische Nachweise der Translokationen spielen in Zukunft eine größere Rolle im diagnostischen Algorithmus. Das vorliegende Positionspapier stellt die aktuellen Empfehlungen zur Qualität und Sequenz der EML4-ALK-Testung, basierend auf der aktuellen Literatur, dar.

Abstract

The EML4-ALK pathway plays an important role in a significant subset of non-small cell lung cancer patients. Treatment options such as tyrosine kinase inhibitors directed against the EML4-ALK signalling pathway lead to improved progression free and overall survival. These therapeutic options are chosen on the basis of the identification of the underlying genetic signature of the EML-ALK translocation. Efficient and easily accessible testing tools are required to identify the patients in time. While FISH techniques have been implemented to characterize this translocation for some time, the implementation of this testing is hampered by its broad use of resources. Immunohistochemical techniques to identify and screen for EML4-ALK translocations may play an important role in the near future. This consensus paper offers recommendations of the sequence and quality of the respective test approaches which are validated on the basis of the current literature.

^* Diese Stellungnahme erscheint ebenfalls in der Zeitschrift „Der Pathologe“, Springer Verlag, DOI: 10.1007/s00292-016-0152-1

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