Comprehensive Biomarker Testing in Early-Stage NSCLC: Identifying Gaps, Challenges, and Strategies for Improvement

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Comprehensive Biomarker Testing in Early-Stage Cancer: Value and Impact on Treatment Planning

Executive Summary

Comprehensive biomarker testing in early-stage cancer provides critical molecular information that influences surgical approaches, neoadjuvant therapy decisions, and adjuvant treatment planning. By identifying actionable mutations and prognostic indicators before surgery, physicians can develop personalized treatment strategies that optimize outcomes and resource allocation.

Key Clinical Implications

• Surgical Planning: Biomarker status informs surgical approach and extent of resection required
• Neoadjuvant Therapy: Molecular profiling identifies patients most likely to benefit from preoperative systemic therapy
• Adjuvant Treatment: Biomarker results guide postsurgical therapy selection and intensity
• Prognostication: Molecular signatures provide more accurate risk stratification than traditional clinicopathological factors alone

Practice Recommendations

• Obtain comprehensive biomarker testing at diagnosis whenever possible
• Use molecular results to inform multidisciplinary treatment planning discussions
• Consider biomarker-directed neoadjuvant approaches in appropriate candidates
• Tailor surgical approach based on molecular subtypes and response prediction
• Select adjuvant therapy based on residual risk assessment from integrated clinicopathological and molecular data

Molecular characterization at diagnosis provides the foundation for precision oncology approaches throughout the treatment continuum, potentially improving outcomes while reducing unnecessary treatments.