Biomarker Testing in NSCLC: Tissue and Liquid Biopsy for Precision Therapy

In this OncLive Medical Lung Insights episode, Dr. Eric Singhi (MD Anderson Cancer Center) and Dr. Chinmay Jani (University of Miami/Sylvester Comprehensive Cancer Center) introduce a series on how biomarkers shape real-world care in non-small cell lung cancer (NSCLC). Dr. Singhi previews the series topics: how molecular features such as STK11, MTAP, TROP2, EGFR, and KRAS influence treatment selection, resistance patterns, and the evolving role of targeted therapies and antibody-drug conjugates.

The first clinical question focuses on the standard approach to molecular testing at diagnosis. Dr. Jani explains that tissue NGS should be sent immediately upon biopsy, and that liquid biopsy NGS should be performed concurrently. He cites his group's published research—in kidney cancer—demonstrating that combining tissue and liquid biopsy identified unique actionable mutations found only on liquid biopsy, reinforcing the value of upfront dual testing to maximize targeted therapy options. Dr. Singhi adds that IHC protein testing remains essential alongside NGS, highlighting PD-L1, MET, HER2, and MTAP loss as increasingly relevant biomarkers.

Dr. Jani raises the question of whether HER2 reflex testing—standard in breast cancer—should be adopted in NSCLC, and at what point: at diagnosis or at progression. This remains an active institutional conversation. The segment establishes comprehensive, complementary biomarker testing as the foundation for precision NSCLC care.

In the next episode, "Adapting to Tumor Evolution: Resistance Mechanisms and Sequencing After Progression," the experts explore how to adjust therapy based on evolving tumor biology and repeat molecular testing strategies.