Niels Reinmuth, MD, PhD

In their closing remarks, the experts synthesize the two pillars of modern lung cancer care: advancing screening to detect early-stage disease and expanding the role of molecular testing. They advocate for simplifying and broadening lung cancer screening criteria to prevent late-stage diagnoses, emphasizing that the best outcome is preventing cancer from progressing to a point where systemic therapy is needed.

Experts compare systems for implementing comprehensive biomarker testing. While the ideal is reflex testing—where NGS is automatically ordered upon a cancer diagnosis—billing and healthcare structures often require a manual order. Both agree that integrating test ordering by the diagnosing physician (e.g., the pulmonologist or surgeon) is crucial to ensure results are available when the medical oncologist first sees the patient.

Experts debate the difficult practice of starting treatment before biomarker testing results are available. They acknowledge that in true emergencies—like symptomatic brain metastases or airway obstruction—immediate intervention with radiation is appropriate and can bridge the time needed for test results.

Experts address the complex role of PD-L1 testing in guiding adjuvant immunotherapy after surgery for resected NSCLC. They highlight the ongoing uncertainty, particularly for PD-L1 negative patients, where clinical trial data is conflicting—some studies show no benefit or even potential harm.

Experts discuss the practical use and limitations of PD-L1 testing in NSCLC. They confirm that testing is standard for all patients, but note results can vary between different PD-L1 test platforms, requiring quality-controlled assays.

Experts address key barriers to lung cancer screening, including public stigma and the misconception that treatments are ineffective. They counter these by highlighting the simplicity of the low-dose CT scan—a rapid, non-invasive test with no preparation.

Experts discuss the recent landmark approval of a national lung cancer screening program in Germany for high-risk individuals. The program, based on the NELSON trial, will use low-dose CT scans for smokers and former smokers aged 50-75 who quit within the last 10 years.

Experts underscore that comprehensive biomarker testing is now essential not just for stage IV non-small cell lung cancer (NSCLC), but also for earlier stages, starting from stage 1b. This is driven by the approval of adjuvant targeted therapies and neoadjuvant regimens, making molecular profiling critical for curative-intent treatment planning.

Experts discuss the critical importance of turnaround time for comprehensive biomarker testing in NSCLC. They compare systems, with one center performing in-house NGS testing and reporting key results like EGFR and ALK via rapid FISH/PCR in 3-5 days, allowing for immediate treatment decisions without waiting for the full NGS report.

Experts address the critical practice of comprehensive biomarker testing for non-small cell lung cancer (NSCLC), highlighting both its necessity and the challenges in implementation. While biomarker testing is mandatory from diagnosis per guidelines, real-world barriers like insufficient tissue from biopsies often prevent complete profiling.

Experts discuss the transformative impact of targeted therapies on outcomes in non-small cell lung cancer (NSCLC). They highlight that before these treatments, survival for stage IV patients was often measured in months. Now, the identification of driver mutations and the use of matched oral targeted therapies have fundamentally changed the disease trajectory.

Niels Reinmuth, MD, PhD, discusses the rationale for a health utility analysis of tepotinib in patients with MET exon 14 skipping mutation–positive non–small cell lung cancer.

Niels Reinmuth, MD, PhD, leader of the Thoracic Oncology Department, Asklepios Lung Clinic, discusses ongoing studies looking at resistance to EGFR TKIs in patients with EGFR-positive non–small cell lung cancer.

Niels Reinmuth, MD, PhD, discusses the results of the MYSTIC study, which evaluated first-line durvalumab plus tremelimumab versus platinum-based chemotherapy in patients with metastatic non–small cell lung cancer.