Expert Insights in the Management of Early-Stage NSCLC With Limited Nodal or Oligometastatic Disease

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Biomarker Testing for NSCLC

Medical professionals routinely perform the following biomarker tests:

Driver Mutations:

• EGFR mutations (exon 19 deletions, L858R, T790M, etc)
• ALK rearrangements
• ROS1 fusions
• BRAF V600E mutations
• NTRK fusions
• MET exon 14 skipping mutations
• RET fusions
• KRAS G12C mutations

Immunotherapy Biomarkers:

• PD-L1 expression (tumor proportion score)
• Tumor mutational burden
• Microsatellite instability status

Testing Methodology:

• Next-generation sequencing panels
• Immunohistochemistry for PD-L1 expression
• Fluorescence in situ hybridization for gene rearrangements

Timing:

• Recommended at diagnosis of advanced disease
• Increasingly recommended for early-stage disease to guide adjuvant therapy decisions
• Consider repeat testing at progression to identify resistance mechanisms

Biomarker results help determine eligibility for targeted therapies and immunotherapy, which may be considered in the adjuvant setting or upon disease progression after initial treatment.