Lung molecular testing climbs

Molecular testing in lung cancer is nearing 70% use, but many patients still start treatment before those results are back. (ajmc.com) These tests look for tumor DNA changes that can steer doctors to a targeted drug instead of standard chemotherapy or immunotherapy alone in non-small cell lung cancer, the most common lung cancer type. The American Society of Clinical Oncology said in its February 27, 2025 living guideline update that treatment recommendations for stage IV disease depend on identifying driver alterations. (ascopubs.org) Christopher D’Avella, a thoracic oncologist quoted by The American Journal of Managed Care in an April 10, 2026 article, said two workflow changes help close the gap: reflex ordering and nurse navigation. Reflex ordering means the pathology team sends tissue for molecular testing automatically after diagnosis, instead of waiting for a separate oncology visit. (ajmc.com) A 2025 review in *The Oncologist* said testing in routine practice is still often late or missed altogether, even as next-generation sequencing panels are strongly recommended. The same review said multidisciplinary teams, rapid specimen evaluation, and reflex testing can cut the time to treatment start. (academic.oup.com) The timing problem shows up in real-world data. A 2025 Journal of the National Comprehensive Cancer Network report using the Flatiron Health database said expert guidelines call for a two-week turnaround for epidermal growth factor receptor and anaplastic lymphoma kinase results in advanced non-small cell lung cancer. (jnccn.org) Testing rates also vary sharply by setting and by patient group. A 2024 *JCO Precision Oncology* study of 17,165 community-practice patients found 67% of all patients with advanced non-small cell lung cancer, and 77% of patients with nonsquamous metastatic disease, had anaplastic lymphoma kinase, epidermal growth factor receptor, and programmed death-ligand 1 testing within 90 days of diagnosis. (ascopubs.org) That same study found lower testing rates in stage IIIB and IIIC disease, in squamous tumors, and in Black patients, and it found large physician-to-physician variation in ordering. Patients with nonsquamous metastatic disease who had all three tests had a median survival of 364 days versus 180 days for patients with none of the three, though the authors said the study could not prove testing itself caused the difference. (ascopubs.org) Nurse navigation is one attempt to fix the delays between biopsy, lab ordering, results, and the first oncology visit. A 2024 *Clinical Journal of Oncology Nursing* report said one cancer system identified biomarker testing as its most time-consuming lung-cancer process in January 2023 and used nurse navigators in a process-improvement effort to speed it up. (pubmed.ncbi.nlm.nih.gov) A broader service model has shown similar results. A 2025 *CHEST* report said a precision-medicine thoracic program that combined reflex testing, nurse navigation, a molecular tumor board, and an information portal increased next-generation sequencing rates, shortened turnaround times, and raised first-line targeted therapy use in stage IV non-small cell lung cancer. (journal.chestnet.org) Professional groups have been pushing toward universal access for years. The American Cancer Society’s National Lung Cancer Roundtable said in a 2024 strategic plan that comprehensive biomarker testing is essential for eligible patients with advanced non-small cell lung cancer and identified cost, access, education, and workflow barriers as persistent obstacles. (pmc.ncbi.nlm.nih.gov) The result is a familiar split in lung cancer care: the science for matching drugs to mutations is moving fast, while clinic operations still decide whether results arrive in time to shape the first treatment plan. (ajmc.com)