La gestione del tumore al polmone non a piccole cellule (NSCLC) ALK positivo – l’esperienza dell’Azienda USL Toscana Nord-Ovest The management of ALK+ NSCLC patients – the experience of the North-West Tuscany area [article in Italian]

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.