Article Details

Authors
Andrea Camerini, Chiara Caparello, Maria Cristina Pennucci, Matteo Rotellini, Irene Stasi, Alessandro Torrini, Enrico Vasile

Article Type
Original Research

DOI
10.7573/dic.2021-8-8

Article Page

Abstract

The ALK (anaplastic lymphoma kinase) gene translocation is an oncogenic driver of fundamental importance in the treatment of non-small-cell lung cancer (NSCLC), thanks to the clinical benefits obtained with the use of specific ALK inhibitors. Consequently, the prompt identification of the ALK status is fundamental for the therapeutic management of ALK+ NSCLC patients. In the USL (Unità Sanitaria Locale) of northwest Tuscany, there was a clear decline in new diagnoses of ALK+ NSCLC in the last year. The “ALK at the center: from science to clinical practice” project was therefore aimed at bringing attention back to the diagnostic process of NSCLC, in order to verify potential critical issues in identifying the state of ALK that preclude specific target treatments. These issues were addressed by a group of experts through a short questionnaire and a consensus activity carried out through the Nominal Group Technique (NGT). The experts reported a good degree of satisfaction regarding the pathological anatomy procedures and the reporting methods of ALK, with the possibility of improvement regarding the timing, the consultation methods and the clarity of the report. The NGT highlighted how the request for the ALK test should concern all NSCLC patients and emphasized the importance of the timeliness of the report. It also emerged that the NGS technique still plays a marginal role in determining the state of ALK. A widely shared opinion also regards the evaluation of the patient’s diagnostic process, which should become a key moment of the GOM (Gruppi Oncologici Multidisciplinari – Multidisciplinary Oncology Groups) and the availability of an adequate amount of sample that has to be considered a priority at the time of tissue sampling.

Keywords: ALK, ALK+, ALK status, diagnostic process of NSCLC, non-small-cell lung cancer, NSCLC, NSCLC ALK+.

Riassunto

La traslocazione del gene ALK (anaplastic lymphoma kinase) è un driver oncogenico di importanza basilare nel trattamento del carcinoma polmonare non a piccole cellule (NSCLC), grazie ai benefici clinici ottenuti con l’utilizzo di inibitori specifici per ALK. Di conseguenza, la tempestiva determinazione dello stato di ALK è fondamentale per la gestione terapeutica dei pazienti NSCLC ALK+. Nell’Azienda USL Toscana Nord Ovest si è riscontrato nell’ultimo anno un chiaro calo delle nuove diagnosi di NSCLC ALK+. Il progetto “ALK al centro: dalla scienza alla pratica clinica” nasce pertanto con l’obiettivo di riportare l’attenzione sull’ iter diagnostico del NSCLC, al fine di verificare che non ci siano criticità nell’identificazione dello stato di ALK che precludano ai pazienti i trattamenti target specifici. Queste tematiche sono state affrontate da un gruppo di esperti tramite un breve questionario e una attività di consensus svolta mediante Nominal Group Technique (NGT). Dal confronto è emerso un buon grado di soddisfazione riguardo le procedure di anatomia patologica e le modalità di refertazione di ALK, con possibilità di miglioramento circa le tempistiche, le modalità di consultazione e la chiarezza del referto. Il confronto mediante NGT ha evidenziato come la richiesta del test di ALK debba riguardare tutti i pazienti NSCLC ed ha enfatizzato l’importanza della tempestività del referto. È emerso inoltre come la tecnica NGS abbia ancora un ruolo marginale nella determinazione dello stato di ALK. È risultata inoltre ampiamente condivisa l’idea che la valutazione dell’iter diagnostico del paziente debba diventare un momento chiave del GOM e che la disponibilità di un’adeguata quantità di campione sia da ritenersi prioritaria al momento del prelievo del tessuto.

Keywords: carcinoma polmonare non a piccole cellule, NSCLC, ALK, NSCLC ALK+, iter diagnostico del NSCLC, stato di ALK.

Citation: Camerini A, Caparello C, Pennucci MC, Rotellini M, Stasi I, Torrini A, Vasile E. La gestione del tumore al polmone non a piccole cellule (NSCLC) ALK positivo – l’esperienza dell’Azienda USL Toscana Nord-Ovest. Drugs Context. 2021;10:2021-8-8. https://doi.org/10.7573/dic.2021-8-8

Contributions: AC contributed to the literature research and wrote the first draft. All other authors have critically contributed to the analysis and discussion of evidence and provided major intellectual input to the paper. All authors have read and approved the final version of the paper before submission. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2021/10/dic.2021-8-8-COI.pdf

Acknowledgements: gli autori ringraziano Simonetta Papa, PhD, Rita Della Pietà e Aashni Shah (Polistudium Srl, Milano) per il supporto (stesura della bozza, assistenza editoriale e revisione critica) nella preparazione del manoscritto.

The authors would like to thank Simonetta Papa, PhD, Rita Della Pietà and Aashni Shah (Polistudium Srl, Milan) for the support (first drafting, editorial assistance and critical review) in the manuscript preparation.

Funding declaration: This study was conducted with the non-conditioning editorial assistance of Roche SpA.

Copyright: Copyright © 2021 Camerini A, Caparello C, Pennucci MC, Rotellini M, Stasi I, Torrini A, Vasile E. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Camerini A, Caparello C, Pennucci MC, Rotellini M, Stasi I, Torrini A, Vasile E. https://doi.org/10.7573/dic.2021-8-8. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/educational_section/la-gestione-del-tumore-al-polmone-non-a-piccole-cellule-nsclc-alk-positivo-lesperienza-dellazienda-usl-toscana-nord-ovest-the-management-of-alk-nsclc-patients

Correspondence: Andrea Camerini, Oncologia Medica-Ospedale Versilia – Azienda USL Toscana Nord Ovest, via Aurelia, 335–55043 Camaiore (LU), Italy. Email: andrea.camerini@uslnordovest.toscana.it

Provenance: Submitted; externally peer reviewed.

Submitted: 23 August 2021; Accepted: 5 October 2021; Publication date: 12 November 2021.

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