Access, Timing, Workflow Challenges Shape Biomarker Testing in NSCLC: Parth Desai, MBBS, MD

Comprehensive biomarker testing in oncology continues to show disparate uptake in real-world practice, despite clear guideline recommendations, particularly in non–small cell lung cancer (NSCLC). According to Parth A. Desai, MBBS, MD, practicing medical oncologist at Temple University and Fox Chase Cancer Center, where he also serves as assistant professor of thoracic medical oncology/head and neck medical oncology, rates vary significantly between academic and community settings.

In academic centers, where resources such as reflex testing protocols are more readily available, testing is performed at consistently high rates across stages of NSCLC, Desai explained in an interview with The American Journal of Managed Care^® at the April 9 Institute for Value-Based Medicine^® event in Philadelphia. This is particularly evident in early-stage and advanced NSCLC, where FDA-approved targeted therapies have reinforced the importance of identifying actionable mutations. In contrast, community practices often face logistical and infrastructure barriers that limit routine implementation of comprehensive testing.

Turnaround time remains a persistent challenge that directly affects treatment decision-making. Desai noted that, in many cases, therapy must be initiated before full biomarker results are available. Tissue-based next-generation sequencing can take approximately 2 to 3 weeks, which may not be feasible for patients requiring immediate intervention. To address this gap, clinicians frequently rely on parallel testing strategies. Liquid biopsy is commonly ordered alongside tissue testing, offering a faster turnaround of about 1 week. Additionally, certain biomarkers, such as PD-L1 expression assessed via immunohistochemistry, can be available within 48 to 72 hours, helping guide initial treatment decisions.

In situations where treatment cannot be delayed, clinicians may begin with chemotherapy while awaiting complete molecular profiling. Desai emphasized that initiating commonly used regimens, such as carboplatin and pemetrexed, does not preclude later transition to targeted therapies once results are available. This approach allows providers to balance urgency with precision.

Overall, integrating next-generation sequencing, liquid biopsy, and rapid PD-L1 testing into a cohesive workflow is critical for optimizing care. However, disparities in access and infrastructure continue to shape how effectively these tools are deployed across different practice settings.