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Updated: Sep 11, 2025
Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Expert recommendations for biomarker evaluation of advanced non-small cell lung cancer in Thailand
Shanop Shuangshoti1,2, Naiyarat Prasongsook3,4, Lucksamon Thamlikitkul4,5
1Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Background:
Growing understanding of the heterogenous molecular profiles of non-small cell lung cancer (NSCLC) has led to changes in the treatment landscape of advanced NSCLC towards precision medicine to target actionable gene alterations. Practical barriers, such as lack of awareness/understanding of biomarkers, suboptimal quality or sample management, inappropriate use of biomarker testing results, limited patient access to biomarker tests and targeted treatments, and reimbursement/payment challenges, hinder the wider adoption of guideline-recommended biomarker testing. Limited reimbursement of targeted therapies is a key consideration for Thai oncologists when making a treatment choice for their patients with advanced NSCLC in Thailand. We aim to assess the current state of biomarker testing and treatment for advanced NSCLC in Thailand and provide recommendations to facilitate timely access to appropriate therapies, enhance patient quality of life, and optimize the use of Thailand's existing healthcare schemes.
Methods:
The expert panel comprising one clinical pathologist, three anatomic pathologists, one molecular geneticist, and four medical oncologists convened to review recent literature, discuss current clinical practice, and prioritize essential topics for biomarker assessment and management of advanced NSCLC in Thailand. Following the meeting, further discussions on these prioritized topics were conducted via email, and the recommendations were developed.
Results:
Our recommendations include adopting an exclusionary strategy for biomarker testing, emphasizing the role of a multidisciplinary team (MDT) in managing patients with advanced NSCLC, and underscoring the importance of laboratory accreditation and external quality assurance programs. Additionally, we highlight the need for high-quality data on the local impact of novel treatments to assist policymakers in making these therapies accessible to suitable patients.
Conclusions:
By proposing practical strategies tailored to our local healthcare setting, such as exclusionary biomarker testing approach, MDT involvement, and robust quality assurance measures, we provide a roadmap for improving the diagnosis and treatment of advanced NSCLC.
Insights
Biomarker testing for advanced non-small cell lung cancer (NSCLC) in Thailand faces barriers. Recommendations include an exclusionary testing strategy and multidisciplinary team involvement to improve access to targeted therapies.
Area of Science:
- Oncology
- Molecular Diagnostics
- Health Services Research
Background:
- Precision medicine for advanced non-small cell lung cancer (NSCLC) relies on targeting specific gene alterations.
- Barriers to biomarker testing include lack of awareness, sample quality issues, and reimbursement challenges, particularly for targeted therapies in Thailand.
- Limited reimbursement for targeted therapies significantly influences treatment decisions for advanced NSCLC in Thailand.
Purpose of the Study:
- To assess the current status of biomarker testing and treatment for advanced NSCLC in Thailand.
- To develop recommendations for improving timely access to appropriate therapies and enhancing patient quality of life.
- To optimize the utilization of Thailand's existing healthcare schemes for advanced NSCLC management.
Main Methods:
- An expert panel of pathologists and oncologists reviewed literature and current practices.
- Discussions focused on prioritizing essential topics for biomarker assessment and management of advanced NSCLC.
- Recommendations were developed through expert consensus and email discussions.
Main Results:
- Adoption of an exclusionary strategy for biomarker testing is recommended.
- Emphasis on the role of multidisciplinary teams (MDT) in managing advanced NSCLC patients.
- Importance of laboratory accreditation and external quality assurance programs highlighted.
Conclusions:
- Practical strategies, including exclusionary biomarker testing and MDT involvement, are proposed for the Thai healthcare setting.
- Robust quality assurance measures are crucial for improving diagnosis and treatment of advanced NSCLC.
- High-quality local data on novel treatments is needed to support policy decisions for therapy accessibility.
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