Introduction
Advances in molecular diagnostics have transformed the management of non-small cell lung cancer (NSCLC), enabling treatment decisions to be guided increasingly by the molecular characteristics of individual tumours. In addition to histological classification, identifying actionable genetic alterations and assessing relevant protein expression can help clinicians determine appropriate targeted therapies and immunotherapy options.[1]
Why Is Comprehensive Biomarker Testing Important?
NSCLC is a heterogeneous disease, with molecular alterations that can influence treatment selection and clinical outcomes. Biomarkers such as EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, NTRK and HER2 can help identify patients who may be eligible for specific targeted treatments. PD-L1 expression can also inform immunotherapy decisions in the appropriate clinical context.[1,2]
Advances in next-generation sequencing (NGS) allow multiple genomic alterations to be assessed through broader molecular profiling. Tissue-based testing remains important, while validated plasma-based testing may provide additional information when tissue is insufficient or when complementary testing is appropriate.
Key Considerations for Clinical Practice
1. Consider testing early in the diagnostic pathway
Timely biomarker assessment can help ensure that relevant results are available before treatment decisions are finalised.
2. Select appropriate testing methods
The choice of tissue-based assays, immunohistochemistry and plasma-based testing should reflect the clinical question, specimen availability and test characteristics.
3. Interpret results in clinical context
A detected alteration should be evaluated alongside disease stage, histology, patient characteristics and current treatment recommendations.
4. Recognise the limitations of negative results
A negative plasma-based test does not necessarily exclude an actionable alteration. Tissue testing or complementary methods may be warranted when clinically appropriate.[1,2]
Conclusion
The integration of molecular diagnostics into lung cancer care represents an important shift towards more individualised treatment. Timely and comprehensive biomarker testing can support informed therapeutic decisions and help clinicians align treatment selection with the biological characteristics of the tumour.
Clinical takeaway: Biomarker testing should be integrated early into the NSCLC treatment pathway to help guide appropriate therapeutic choices.
References
1. American Society of Clinical Oncology. Therapy for Stage IV Non–Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2026.3.2. Journal of Clinical Oncology.
Journal of Clinical Oncology
2. Lindeman NI, et al. Updated Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment With Targeted Tyrosine Kinase Inhibitors. Archives of Pathology & Laboratory Medicine. 2018;142(3):321–346. DOI: 10.5858/arpa.2017-0388-CP