Understanding genomic testing in NSCLC
Genomic testing for non-small cell lung cancer (NSCLC) has evolved from a optional add-on to a cornerstone of personalized care. At the recent AONN+ conference, a focused session explored how oncology nurses, advanced practitioners, and navigators can effectively use biomarker testing to inform treatment decisions across NSCLC subtypes. The goal is to ensure every patient undergoes the right panel of tests promptly, enabling timely therapy selection and improved outcomes.
Core biomarker targets across NSCLC subtypes
Testing strategies in NSCLC are driven by histology (adenocarcinoma vs. squamous) and clinical factors like smoking history and disease stage. Key molecular targets discussed at the session include:
- EGFR mutations – particularly common in non-smokers with adenocarcinoma; testing guides first-line EGFR inhibitor therapy.
- ALK and ROS1 rearrangements – often seen in younger patients and non-smokers; targeted inhibitors can yield dramatic responses.
- BRAF V600E alterations – a subset of NSCLC patients who may respond to BRAF/MEK inhibition strategies.
- KRAS G12C and other KRAS mutations – recently expanded options with KRAS inhibitors in select settings.
- MET exon 14 skipping and MET amplification – potential beneficiaries of MET inhibitors in appropriate contexts.
- HER2 alterations – emerging targets for select NSCLC cases with targeted therapies under investigation.
- NTRK fusions – rare but actionable with TRK inhibitors when present.
- PD-L1 expression and tumor mutational burden – guidance for immunotherapy suitability, often in combination with other markers.
The session emphasized that comprehensive profiling often yields the most actionable data. A panel approach that includes DNA sequencing for gene alterations and, when possible, RNA sequencing for fusions can capture a broader set of targets than single-gene tests.
Practical roles for navigators and nurses
Oncology navigators play a pivotal role in coordinating testing timelines, interpreting complex reports, and communicating results in ways that patients comprehend. The session highlighted several practical practices:
- Early test ordering: Align biomarker testing with diagnostic pathology at initial biopsy to minimize delays in treatment planning.
- Multidisciplinary collaboration: Engage pathologists, molecular biologists, and medical oncologists to ensure appropriate test selection and result interpretation.
- Turnaround time awareness: Track lab processing times and pursue reflex testing when indicated to avoid postponing therapy decisions.
- Educating patients: Explain the meaning of results, the rationale for targeted therapies, and potential access issues to minimize anxiety and improve adherence.
- Re-testing and progression: Be prepared to re-biopsy or reassess biomarker status if disease progresses or histology changes after treatment.
Given the rapidly evolving biomarker landscape, navigators should stay informed about emerging tests, trial options, and reimbursement pathways. This ensures patients can access both approved targeted therapies and appropriate clinical trials.
Workflow integration and patient-centered care
Implementing efficient genomic testing requires a patient-centered workflow: clearly defined testing panels, streamlined consent processes, and proactive genetic counseling when hereditary risk is a consideration for certain biomarkers. The session underscored the importance of aligning testing with treatment pathways, so patients can begin targeted therapies promptly if a biomarker is identified.
Looking ahead for NSCLC biomarker testing
As NSCLC research advances, panels will continue to expand, and novel biomarkers may inform second- and third-line strategies. Navigators will increasingly rely on real-time evidence summaries, updated guidelines, and access programs to help patients navigate cost considerations and drug availability. The overarching message from the AONN+ session was clear: timely, comprehensive genomic testing is a cornerstone of modern NSCLC care, and well-informed navigators are essential to delivering precision medicine in a patient-friendly manner.
