Awaiting biomarker testing results for EGFR mutations and ALK rearrangements can delay treatment decisions and treatment initiation for patients with advanced non-small cell lung cancer (NSCLC), a new study published online early in the journal Annals of Oncology has shown.

For the study, researchers sought to assess the prevalence of biomarker testing for patients with advanced NSCLC and whether testing affected the time to making treatment decisions.

Researchers reviewed data from 300 patients with advanced NSCLC who were referred to the Princess Margaret Cancer Centre in Toronto, Ontario, Canada. Of those, 126 with non-squamous NSCLC had biomarker testing performed.

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Results showed that patients tested for biomarkers were more likely to be female (= 0.002), Asian (P = 0.005), and never-smokers (P < 0.0001).

Researchers found that the only 21% of patients who had biomarker testing performed had available results at the time of initial oncology consultation.

Those patients had a shorter median time from consultation to treatment decision (0 vs. 22 days, = 0.0008) and a shorter time to initiation of treatment (16 vs. 29, P = 0.004).

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In addition, 13% of those who had biomarker testing underwent repeat biopsy for molecular testing following the initial consultation.

The authors suggest that the delays “may be avoided by incorporating reflex biomarker testing into diagnostic algorithms for NSCLC at the level of the pathologist, and further education of specialists involved in obtaining diagnostic cancer specimens to ensure they are sufficient for molecular testing.”


  1. Lim C, Tsao MS,  Le LW, et al. Biomarker testing and time to treatment decision in patients with advanced non-small cell lung cancer. Ann Oncol. 2015. [Epub ahead of print]. doi: 10.1093/annonc/mdv208.