Molecular Testing for Treatment of Metastatic Non-Small Cell Lung Cancer: How to Implement Evidence-Based Recommendations

Therecentdiscoveryof relevant biomarkershasreshapedour approach to therapy selection for patients with non-small cell lungcancer.Theunprecedentedoutcomesdemonstratedwith tyrosine kinase inhibitors in molecularly defined cohorts of patients has underscored the importance of genetic profiling in this disease. Despite published guidelines on biomarker testing, successful tumor genotyping faces significant hurdles atbothacademicandcommunity-basedpractices.Oncologists are now faced with interpreting large-scale genomic data from multiple tumor types, possibly making it difficult to stay current with practice standards in lung cancer. In addition, physicians’ lack of time, resources, and face-to-face opportunities can interfere with the multidisciplinary approach that is essential to delivery of care. Finally, several challenges exist in optimizing the amount and quality of tissue for molecular testing. Recognizing the importance of biomarker testing, aseriesofadvisoryboardswererecentlyconvenedtoaddress these hurdles and clarify best practices. We reviewed these challengesandestablishedrecommendationstohelpoptimize tissue acquisition, processing, and testing within the framework of a multidisciplinary approach. The Oncologist 2015; 20:1–7 Implications for Practice: Although several professional societies have incorporated biomarker testing recommendations into clinicalpracticeguidelinesforthediagnosisandmanagementofnon-smallcelllungcancer(NSCLC),healthcareprovidersstillface considerablechallengeswhenestablishingandimplementingthesestandards.Developingandinstitutingprotocolstoensurethat allappropriatepatientsaretestedformolecularbiomarkersrequirescommunicationamongthevariousspecialistsinvolvedinthe care of patients with NSCLC. This report provides insights into key challenges and recommendations for molecular testing of patients with metastatic NSCLC, summarized from a multidisciplinary team of experts spanning academic, community, and integrated health systems.