Dr Pannu on Molecular Testing in Lung Cancer at The Ohio State University Wexner Medical Center

“At our institution, if we have a preliminary suspicion or an indication by our cytotechnologist that this could be…a non–small cell [lung cancer], we may order these markers at the very time of diagnosis. We want to stay ahead as much as possible, because [the results] do take some time to…come back.”

Jasleen Pannu, MBBS, an associate professor at The Ohio State University Wexner Medical Center, discussed how proactive biomarker ordering and close multidisciplinary collaboration are essential to preventing treatment delays and ensuring that patients receive the most appropriate first-line therapy in lung cancer.

Institutional workflows and insurance coverage can influence when molecular testing is initiated, according to Pannu. However, at her institution, if there is a preliminary suspicion of a molecular abnormality, particularly in cases consistent with non–small cell lung cancer, biomarker testing is often ordered at the time of diagnosis. This anticipatory approach is designed to stay ahead of potential delays, as comprehensive molecular assays can require significant turnaround time. Without early ordering, oncologists may find themselves in clinic appointments without complete data, forcing treatment decisions to be deferred while awaiting results, Pannu explained.

To mitigate this risk, biomarker testing has been embedded as a routine component of the diagnostic workflow, particularly for patients with stage II or higher disease, Pannu said. By integrating reflexive or early testing strategies, the team aims to reduce the time between diagnosis and treatment initiation, ensuring that actionable results are available when systemic therapy decisions are being made.

Pannu attributed much of her institution’s efficiency to a highly integrated multidisciplinary model. Weekly tumor boards and shared clinical space foster real-time collaboration among pathologists, thoracic oncologists, thoracic surgeons, and interventional pulmonologists. This proximity enables immediate dialogue regarding biopsy adequacy, disease progression, and procedural planning. For example, when additional tissue is required due to insufficient sampling or evolving disease, the team can quickly determine the most appropriate and least invasive method for obtaining a new specimen, Pannu shared.

This open exchange not only streamlines patient care but also facilitates cross-disciplinary learning, as each specialty adapts to advances and evolving standards within the others’ fields. Such coordination helps anticipate challenges, such as the need for repeat biopsies or expanded molecular panels before they translate into clinical delays, she explained.

Importantly, Pannu noted that failure to obtain timely molecular results can have tangible consequences. In urgent scenarios where testing has not been performed or results are pending, patients may be started on therapies that are not optimally aligned with their tumor biology, she stated. Ensuring that comprehensive biomarker data are available upfront can significantly influence outcomes by guiding the selection of the most appropriate targeted or systemic therapy from the outset.

Ultimately, early, integrated testing is not simply a logistical consideration but a critical determinant of high-quality, personalized cancer care, Pannu concluded.