Molecular Testing Recommendations for NSCLC

Julie R. Brahmer, MD, co-director of the Upper Aerodigestive Department in the Bloomberg-Kimmel Institute for Cancer Immunotherapy, director of Thoracic Oncology, and professor of oncology, Johns Hopkins Medicine, discusses the role of molecular testing for patients with lung cancer and why this is particularly important for those with early-stage disease.

Guidelines recommend that all patients with non—small cell lung cancer undergo molecular testing at the time of diagnosis, Brahmer says. This is especially important in patients with advanced disease, though. For patients with early-stage disease, physicians are not routinely using driver mutations or standard therapy, adjuvant chemotherapy. These patients also should still receive molecular testing upon diagnosis.

There are many clinical trials ongoing, so checking for mutations, fusions, and other alterations may help determine which patients should be placed in a study. For example, Brahmer says patients with EGFR or ALK fusions in their tumors could be placed in the ALCHEMIST trial or others that are happening in the adjuvant setting.

For patients with advanced disease, all patients should receive molecular testing to determine the presence of driver mutations or fusions that may change their prognosis and direct physicians to a specific targeted therapy, Brahmer concludes.

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