Pathologist-initiated reflex testing for biomarkers in non-small-cell lung cancer: expert consensus on the rationale and considerations for implementation

J R Gosney; L Paz-Ares; P Jänne; K M Kerr; N B Leighl; M D Lozano; U Malapelle; T Mok; B S Sheffield; A Tufman; I I Wistuba; S Peters

doi:10.1016/j.esmoop.2023.101587

Pathologist-initiated reflex testing for biomarkers in non-small-cell lung cancer: expert consensus on the rationale and considerations for implementation

ESMO Open. 2023 Aug;8(4):101587. doi: 10.1016/j.esmoop.2023.101587. Epub 2023 Jun 23.

Authors

J R Gosney¹, L Paz-Ares², P Jänne³, K M Kerr⁴, N B Leighl⁵, M D Lozano⁶, U Malapelle⁷, T Mok⁸, B S Sheffield⁹, A Tufman¹⁰, I I Wistuba¹¹, S Peters¹²

Affiliations

¹ Department of Cellular Pathology, Royal Liverpool University Hospital, Liverpool, UK.
² Hospital Universitario 12 de Octubre, H12O-CNIO Lung Cancer Unit, Ciberonc and Complutense University, Madrid, Spain.
³ Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA.
⁴ School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
⁵ Princess Margaret Cancer Centre, Toronto, Canada.
⁶ Pathology, Universidad de Navarra-Clínica Universidad de Navarra, Pamplona, Spain.
⁷ Department of Public Health, University of Naples Federico II, Naples, Italy.
⁸ Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁹ Department of Pathology and Laboratory Medicine, William Osler Health System, Brampton, Canada.
¹⁰ Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig Maximilian University, Munich; Comprehensive Pneumology Center Munich (CPC-M), Munich; German Center for Lung Research (DZL), Munich, Germany.
¹¹ Departments of Thoracic/Head and Neck Medical Oncology; Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
¹² Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Electronic address: solange.peters@chuv.ch.

Abstract

Biomarker tests in lung cancer have been traditionally ordered by the treating oncologist upon confirmation of an appropriate pathological diagnosis. The delay this introduces prolongs yet further what is already a complex, multi-stage, pre-treatment pathway and delays the start of first-line systemic treatment, which is crucially informed by the results of such analysis. Reflex testing, in which the responsibility for testing for an agreed range of biomarkers lies with the pathologist, has been shown to standardise and expedite the process. Twelve experts discussed the rationale and considerations for implementing reflex testing as standard clinical practice.

Keywords: NSCLC; molecular pathology; non-small-cell lung cancer; predictive biomarkers; reflex testing; turnaround time.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomarkers, Tumor
Carcinoma, Non-Small-Cell Lung* / drug therapy
Carcinoma, Non-Small-Cell Lung* / therapy
Consensus
Humans
Lung Neoplasms* / drug therapy
Lung Neoplasms* / therapy
Pathologists
Reflex

Substances

Biomarkers, Tumor