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Updated: Aug 22, 2025
Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Barriers in precision medicine implementation among Advanced Nonsquamous Cell Lung Cancer-patients: A Real-World
Flavia A Duarte1, Carlos Gil Ferreira2, Rodrigo Dienstmann3
1Oncology Department, Oncoclínicas do Brasil, Belo Horizonte, Brazil.
Background:
Precision oncology has a prominent role in nonsquamous non-small cell lung cancer (nsNSCLC) treatment progress; however, its access in a real-world scenario might be limited.
Objective:
To investigate the time spent in nsNSCLC molecular profile evaluation and its influence on clinical decisions.
Methods:
nsNSCLC patients who underwent molecular testing in a private referral Brazilian center between November 2015 and February 2020 were identified. The interval from nsNSCLC diagnosis to the characterization of the molecular profile was determined. Other outcomes, focusing on the biomarker tissue journey, were also assessed.
Results:
In this cohort (n = 78), the median time between the advanced nsNSCLC diagnosis and biomarker characterization was 40.5 days (range, 29.5-68.5). The median interval between the diagnosis and the test request was longer than the interval between the request and the results (respectively 29.0 versus 12.0 days; p < 0.001). At the treatment initiation, 51% (36/71) of the patients who received any systemic therapy did not have their driver mutations panel results available. But on these, 42% (15/36) had a targetable alteration identified later on. Among patients harboring a targetable alteration, only 46% (n = 13/28) received a tyrosine kinase inhibitor (TKI) as first-line therapy. The median time to the TKI initiation was even longer than the median time to all treatment initiation (92.0 versus 40.0 days).
Conclusions:
Our data show a long median time from advanced nsNSCLC diagnosis and the availability of the biomarker testing in medical practice, which impacted the choice of a non-personalized therapy as the first-line.
Insights
Delays in molecular profiling for advanced nonsquamous non-small cell lung cancer (nsNSCLC) hinder precision oncology. Long turnaround times for biomarker testing impact first-line treatment decisions, often leading to non-personalized therapy.
Area of Science:
- Oncology
- Molecular Diagnostics
- Clinical Decision Making
Background:
- Precision oncology is crucial for nonsquamous non-small cell lung cancer (nsNSCLC).
- Real-world access to precision oncology in nsNSCLC may be limited.
- Timely molecular profiling is essential for effective nsNSCLC treatment.
Purpose of the Study:
- To investigate the time required for molecular profiling in nsNSCLC.
- To assess the impact of molecular testing timelines on clinical decisions in nsNSCLC.
- To evaluate the biomarker tissue journey in nsNSCLC patients.
Main Methods:
- Retrospective analysis of nsNSCLC patients undergoing molecular testing.
- Inclusion of patients from a Brazilian private referral center (November 2015 - February 2020).
- Determination of time intervals from diagnosis to molecular profile characterization and treatment initiation.
Main Results:
- Median time from diagnosis to biomarker characterization was 40.5 days.
- Time from diagnosis to test request was significantly longer than request to results (29.0 vs 12.0 days).
- 51% of patients lacked driver mutation results at treatment initiation; 42% of these had targetable alterations identified later. Only 46% with targetable alterations received a TKI first-line.
Conclusions:
- A significant delay exists between advanced nsNSCLC diagnosis and biomarker test availability.
- These delays negatively impact the selection of first-line therapy, often resulting in non-personalized treatment.
- Optimizing the molecular testing workflow is critical to improve outcomes in nsNSCLC.
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