Access to Molecular Testing Across Institutions: Barriers, Resources, and Real-World Solutions

In this segment, Dr. Jani opens by asking how biomarker testing access varies across academic and community settings, including the choice between comprehensive and smaller NGS panels, turnaround time considerations, and how to leverage molecular tumor boards.

Dr. Singhi responds that truly comprehensive, patient-centered biomarker testing is complex and institution-dependent. Key requirements include in-house NGS, rapid testing pipelines, reflex pathology workflows, access to plasma ctDNA, and multidisciplinary interpretation through molecular tumor boards. He identifies several persistent barriers: insufficient tissue, delayed test ordering, lack of reflex workflows, and financial hurdles. He also addresses the clinical pressure to start treatment before results return—from both physicians and patients—and emphasizes that real-world data, albeit retrospective, show that patient outcomes improve when biomarker results are available before initiating therapy. He calls for education of patients, families, and providers to reinforce this message.

Dr. Jani adds a key supporting point: a recent study demonstrated that even if chemoimmunotherapy has already been started, identifying an actionable alteration within one or two cycles and switching to targeted therapy still improves outcomes. He stresses that this finding reinforces the importance of testing at any time if it was not done upfront, and changing treatment as soon as a targetable alteration is found.

In the next episode, "KRAS Mutations in NSCLC: Sequencing Across Lines," the experts discuss how KRAS subtypes inform post-progression and frontline strategies.