Comprehensive Molecular Testing in Early-Stage NSCLC: Best Practices and Multidisciplinary Strategies

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Current Approach to Molecular Testing in Early-Stage NSCLC

Early-stage NSCLC patients increasingly benefit from molecular testing, though implementation varies across practice settings. The current landscape includes.

• Most centers perform biomarker testing after surgical resection rather than at diagnosis
• Testing primarily focuses on identifying targetable alterations, particularly EGFR mutations
• Molecular profiling is expanding beyond EGFR to include ALK, ROS1, BRAF, MET, RET, and NTRK
• NGS panel testing is becoming more common but isn’t universally implemented
• Testing rates remain suboptimal with significant disparities across health care settings
• Guidelines generally recommend biomarker testing for patients with stage IB-IIIA disease, particularly those with nonsquamous histology
• Results increasingly guide adjuvant targeted therapy decisions, especially following FDA approval of osimertinib for EGFR-positive patients
• Barriers include tissue availability, turnaround time, and lack of standardization
• Liquid biopsy adoption is increasing as a complementary approach but hasn’t replaced tissue-based testing