Overview: Why Genomic Testing in NSCLC Matters for Navigators
Genomic testing has become a cornerstone of non-small cell lung cancer (NSCLC) management. At the AONN+ conference, a dedicated session offered practical insights for oncology nurses, advanced practitioners, and navigators who guide patients through complex diagnostic and treatment pathways. The session emphasized that understanding which biomarker tests to order, how to interpret results, and how to communicate implications to patients is essential for delivering timely, personalized care.
Key Biomarkers Every Navigator Should Know
NSCLC is heterogeneous, and several genetic alterations influence therapy decisions. The session highlighted several core biomarkers and testing strategies:
- EGFR mutations – Common drivers in certain NSCLC subtypes; often predict sensitivity to EGFR inhibitors.
- ALK and ROS1 rearrangements – Targetable alterations with specific tyrosine kinase inhibitors (TKIs).
- KRAS G12C and other KRAS mutations – Emerging targets with dedicated therapies in select settings.
- PD-L1 expression and tumor mutational burden (TMB) – Immunotherapy eligibility considerations and potential predictive value for response.
- MET, HER2, and NTRK alterations – Less common but clinically actionable in certain patients.
In addition to these targets, the session underscored the importance of broad Next-Generation Sequencing (NGS) panels that can detect multiple alterations in a single test. This approach minimizes turnaround time and maximizes the chance of identifying a matched therapy option for the patient.
Testing Strategies: When and What to Test
The audience heard practical guidance on sequencing tests to optimize patient flow. Factors influencing testing decisions include tumor histology (squamous vs. non-squamous), smoking history, stage, prior therapies, and access to targeted agents. Key takeaways:
- First-line vs. acquired resistance testing: Initial comprehensive profiling is recommended for most advanced NSCLC cases, with repeat testing guided by therapy changes or progression.
- Liquid biopsies as a complement: Circulating tumor DNA (ctDNA) can provide timely insights when tissue is insufficient or unavailable, though it may not capture all alterations detected by tissue-based NGS.
- Turnaround time matters: Delays in biomarker results can affect treatment initiation. Navigators should anticipate testing windows and coordinate with pathology and molecular laboratories to streamline processes.
- Bioinformatic interpretation: Mutations of uncertain significance require cautious interpretation and, when possible, correlation with clinical data and multidisciplinary input.
Effective communication with patients about the purpose and implications of genomic testing is essential. Navigators should explain that biomarker results can expand or narrow treatment options, including targeted therapies, immunotherapy, and ongoing clinical trials.
Role of the Navigator in Biomarker-Driven Care
Navigators bridge the gap between complex molecular data and patient-centered care. The session outlined several practical roles for oncology navigators:
- Scheduling and logistics: Ensure tissue collection, NGS testing, and result delivery align with the patient’s treatment plan and clinical milestones.
- Education and counseling: Provide clear explanations of what a biomarker result means, potential side effects of matched therapies, and the likelihood of benefit based on current evidence.
- Access and equity considerations: Identify barriers to testing, such as insurance coverage or specimen adequacy, and advocate for alternatives like ctDNA when tissue is limited.
- Coordination of care: Facilitate entry into targeted therapy trials or FDA-approved therapies that match a patient’s biomarker profile, coordinating with medical oncologists, pharmacists, and genetic counselors.
Practical Takeaways for Daily Practice
For oncology navigators, the session offered concrete steps to integrate genomic testing into routine patient care:
- Adopt a standard panel approach for eligible NSCLC patients to maximize likelihood of identifying a targetable alteration.
- Incorporate ctDNA testing as a flexible option when tissue samples are scarce or slow to arrive, while recognizing its limitations.
- Develop a checklist of actionable biomarkers to discuss with patients, so conversations are consistent and informative across care teams.
- Foster collaboration with pathology and molecular pathology labs to reduce reporting delays and clarify any ambiguous results.
Looking Ahead: The Evolving Landscape
As NSCLC therapies become more personalized, the role of genomic testing will only grow in importance. The conference session reinforced that staying current with evolving biomarkers and new targeted agents is essential for navigators. Continuous education, multiprofessional collaboration, and patient-centered communication will ensure that patients receive timely, precise treatments aligned with their tumor biology.
