Barriers to implementation

2,3 Biomarker-directed therapy may significantly improve treatment outcomes, including response, quality of life and progression-free survival, 1 and in some cases may even improve overall survival. Canadian consensus guidelines on biomarker testing in lung cancer have been published, 4 and multiple personalized treatment options in advanced lung cancer, based on biomarker testing, are now funded in provinces across Canada. But most patients are still not getting the molecular pathology testing that would permit them to receive personalized lung cancer therapy. Several barriers continue to hinder the application of this knowledge, including lack of integration of biomarker testing into routine pathology practice, lack of knowledge dissemination to involved specialties (beyond medical oncology and academic pathology), absence of specific or sufficient funding for biomarker testing, and insufficient tumour samples for testing. All of these culminate in Canada’s current failure to routinely offer the “right drug to the right person at the right time” in lung cancer. Recent studies in patients with metastatic non-small cell lung cancer (NSCLC) have demonstrated that response to systemic treatment depends on pathologic subtype and the presence of specific alterations within the NSCLC genome. 5 It is of pressing clinical importance to determine the histopathologic and molecular features of NSCLC tumours in order to guide appropriate treatment options for patients. 6