The identifying of molecular biomarkers is critical for optimizing treatment with targeted drugs in lung cancer both nonmetastatic as well as metastatic NSCLC. Given that current recommendations mostly available in Europe and North America, where patient characteristics and tumor molecular profiles differ markedly between Asian and Western world, this consensus and standardization regarding biomarker testing specific for Asian could be beneficial in your clinical practice.

Key Takeaway

• At diagnosis, along with PD-L1, EGFR, ALK, and ROS1, other driver alterations should be considered when relevant targeted therapies are available.
• At the time of disease progression on first-generation EGFR TKIs, identifying for the presence of EGFR T790M is essential, while more comprehensive testing may be considered for progression on third-generation EGFR TKIs.
• Progression on other targeted therapies, the probability of identifying a potentially actionable alteration before testing should be considered.
• Tissue sample is preferred. Assessment of plasma for ctDNA is an alternative option in cases of limited tissue sample or inconclusive results or when rebiopsy is not feasible.
• Each testing platforms has its advantages and challenges. Potential factors that should be concerned including cost, quality, access, awareness, and turnaround time. The panel also considered the factors associated with patients’ preference such as clinical condition of the patient, prior treatment history, biomarker testing history, and access to relevant targeted therapies.

Mitsudomi T, Tan D, Yang JC, et al. Expert Consensus Recommendations on Biomarker Testing in Metastatic and Nonmetastatic NSCLC in Asia. J Thorac Oncol. 2023;18(4):436-446.

For more information, please visit doi: 10.1016/j.jtho.2022.10.021