Optimizing Early-Stage NSCLC Management: A Multidisciplinary Perspective - Episode 3
Optimizing Molecular Testing, Diagnosis, and Workflow in Early-Stage NSCLC Through Multidisciplinary Collaboration
Panelists discuss how collaboration between pathologists, oncologists, and pulmonologists is essential for timely next-generation sequencing (NGS) testing in early-stage non–small cell lung cancer (NSCLC), emphasizing that molecular testing should ideally be ordered at diagnosis with prioritization of EGFR, ALK, ROS1, BRAF, MET, KRAS, RET, and NTRK biomarkers to guide treatment decisions before surgical intervention.
Video content above is prompted by the following:
NGS Testing in NSCLC: Workflow Summary for Physicians
Testing Workflow and Team Collaboration
- Primary Test Orderers: Typically, pathologists, pulmonologists, thoracic surgeons, or medical oncologists order NGS testing, depending on institutional workflows
- Multidisciplinary Approach: Effective collaboration between pathology, pulmonology, thoracic surgery, and oncology ensures efficient testing
- Communication Strategies: Regular molecular tumor boards, integrated electronic medical record systems, and designated testing coordinators streamline result communication
- Critical Factors: Close collaboration between specimen handling teams and clinical teams prevents delays and ensures adequate tissue preservation
Optimal Timing for Molecular Testing
- Early-Stage NSCLC: NGS testing should be performed immediately after diagnosis/surgical resection
- Test Initiation: Ideally triggered automatically by pathology at diagnosis rather than requiring separate clinician orders
- Result Timeline: Results should be available before adjuvant therapy decisions (typically within 2-3 weeks post surgery)
Prioritized Biomarkers in Early-Stage NSCLC
- Essential Biomarkers: EGFR mutations (particularly exon 19 deletions and L858R), ALK rearrangements, ROS1 fusions
- Additional Important Markers: KRAS G12C, BRAF V600E, MET exon 14 skipping, RET fusions, NTRK fusions
- Emerging Markers: HER2 mutations, NRG1 fusions
- Immunotherapy-Related: PD-L1 expression (complementary to NGS testing)
Recommendations
- Implement reflex testing protocols where pathology automatically initiates NGS upon NSCLC diagnosis
- Utilize comprehensive NGS panels rather than sequential single-gene testing to preserve tissue
Consider liquid biopsy when tissue is insufficient or to complement tissue testing
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