Molecular Testing of Metastatic Non-Small Cell Lung Cancer in the Asia-Pacific Region

The management of advanced non-small cell lung cancer (NSCLC) patients has become more complex with the identification of many oncogenic drivers starting with epidermal growth factor receptor (EGFR) mutation and the availability of therapies specifically targeting these molecular alterations resulting in improved treatment outcomes. Molecular biomarker testing of NSCLC is now considered standard of care and part of the diagnostic algorithm to identify subsets of patients for molecular-targeted treatment. With the increasing use of small biopsies and cytological specimens for diagnosis and the need to identify an increasing number of predictive biomarkers, proper management of the limited amount of sampling materials available is important. A limited diagnostic workup is recommended to preserve sufficient tissue for molecular testing. Molecular testing of lung adenocarcinoma for alterations in the EGFR, ALK and ROS1 genes is now considered standard of care while emerging predictive biomarkers such as mutations in BRAF, HER2, MET exon 14, RET, and NTRK may be included in an expanded panel testing. The extent of therapy-predictive biomarker testing is dependent on the approval and reimbursement status of the recommended therapeutic agents in each country or institution. When selecting a testing method, timeliness of results availability for treatment decision-making needs to be considered. Turnaround time should not be more than 10 working days from receipt of sample to reporting of all results. This position statement recommends molecular profiling of metastatic NSCLC at diagnosis of and at disease progression following first-line targeted therapy as this impacts on the treatment outcomes of patients.