[Perioperative Molecular Testing in Non-small Cell Lung Cancer]

Non-small cell lung cancer (NSCLC) is known to exhibit high tumor heterogeneity, and molecular alterations can be detected in a relevant proportion of patients. These alterations may permit the use of targeted therapy but also have important implications for the use of other therapies particularly immune checkpoint inhibitors. Therefore, comprehensive characterization of the molecular profile is crucial for achieving optimal therapeutic outcomes in the perioperative setting even in early stages. A wide range of diagnostic techniques with specific advantages and limitations are currently available for molecular testing of NSCLC. The choice of method depends on the clinical setting and the available tissue. Modern next-generation sequencing panels currently represent the diagnostic gold standard in this regard. Numerous studies are currently investigating the use of various targeted therapies for molecularly altered NSCLC in adjuvant, neoadjuvant, and perioperative settings, and have in some cases yielded spectacular improvements of disease-free- as well as overall survival. The results of the ADAURA trial led to the approval of osimertinib for adjuvant treatment of completely resected, EGFR-mutated NSCLC, while the ALINA trial provided the basis for the approval of alectinib in the adjuvant treatment of ALK-positive, completely resected NSCLC. This article discusses the current evidence regarding the perioperative use of targeted therapies, the recommendations for molecular testing in non-small cell lung cancer, and the resulting therapeutic implications, as well as ongoing research efforts in this evolving field.